TREATISE j^r 

UPON THE 

SEMEIOLOGY OF THE EYE, 

FOB THE 

USE OF PHYSICIANS ; 

AND 

OF THE COUNTENANCE, 

FOR 

CRIMINAL JURISPRUDENCE . 



v 3 ' \* V 
BY J. F. DANIEL LOBSTEIN, M. D. 

Of the Faculty of Paris ; late Physician of the Military Hospitals and Army of France ; late 
Lecturer on Surgery and Midwifery, and second Physician and Accoucheur of the Civil 
Hospital at Strasburg in France ; Corresponding Member of the Medical Societies of Paris, 
of Bordeaux, of Toulouse, and Marseilles ; of the Latin and Mincralogical Society of 
Jena; Honorary Member of the Medical Societies of Philadelphia, of the City and County 
of New- York, of Massachusetts, of Maryland, of Lexington in Kentucky, of New- Oi lcan.:., 
of Pittsburg in Pennsylvania, and of several other learned and benevolent Societies of the 
United State3 of North America ; Physician, and Practitioner in Midwifery in New- York 



NEW-YORK: 
C. S. FRANCIS, 252 BROADWAY ; 

SOLD ALSO BY 

TO WAR & HOG AN, PHILADELPHIA ; CARTER & llLi\DEE, BOSTON 



T. SEYMOUR TRJ INTER, JOHN STREET 

1830. 



Southern District of New- York, ss. 

BE IT REMEMBERED, That on the sixthday of January, A. D. 1830, in the fifty-fourth 
year of the Independence of the United States of America, Jonathan Seymour, of the 
said District, hath deposited in this office the title of a book, the right whereof he claims as 
proprietor, in the words following, to wit : 

" A Treatise upon the Semeiology of the Eye, for the use of Physicians ; and of the 
Countenance, for Criminal Jurisprudence. By J. F. Daniel Lobstein, M. D. of the Faculty 
of Paris ; late Physician of the Military Hospitals and Army of France ; late Lecturer on 
Surgery and Midwifery, and second Physician and Accoucheur of the Civil Hospital 
at Strasburg in France ; Corresponding Member of the Medical Societies of Paris, of 
Bordeaux, of Toulouse, and Marseilles ; of the Latin and Mineralogical Society of Jena : 
Honorary Member of the Medical Societies of Philadelphia, of the City and County of 
New-York, of Massachusetts, of Maryland, of Lexington in Kentucky, of New-Orleans, 
of Pittsburg in Pennsylvania, and of several other learned and benevolent Societies of the 
United States of North America ; Physician and Practitioner in Midwifery in New- York." 

In conformity to the act of Congress of the United States, entitled " an act for the 
encouragement of learning, by securing the copies of maps, charts, and books, to the 
authors and proprietors of such copies, during the time therein mentioned." And also to 
an act, entitled " An act, supplementary to an act, entitled an act for the encouragement 
of learning, by securing the copies of maps, charts, and books, to the authors and proprie- 
tors of such copies, during the times therein mentioned, and extending the benefits thereof 
to the arts of designing, engraving, and etching historical and other prints." 

FREDERICK J. BETTS, 
Clerk of the Southern District of New- York. 



10 



SAMUEL L. MITCHILL, M. D. F.R. S. L. & E. Vice President of Rutgers College. 

DAVID HOSACK, M.D. F.R.S. L.&E. Prof, of Theory & Practice of Phys. Rutgers Col. 

FELIX PASCALIS, M. D. late Censor of the State Society of New- York. 

JOHN W. FRANCIS, M.D. Professor of Obstetrics, Rutgers College. 

WM. JAMES MACNEVEN, Professor of Materia Medica, Rutgers College. 

VALENTINE MOTT, M. D Professor of Surgery, Rutgers College. 

WM. HAMERSLEY, late Professor of Rutgers College. 

J. Me.CARTNEY BUSH, Professor of Rutgers College. 

JOHN WATTS, M. D. President of the College of Physicians. 

SAMUEL W. MOORE, M.D. President of the Medical Society. 

DANIEL L. M. PEIXOTTO, M. D. Vice-President of the Medical Society. 

JOSEPH M. SMITH, Prof, of Theory and Practice of Physic, Coll, of Phys. & Surgeons. 

A. H. STEVENS, Professor of Surgery, College of Physicians and Surgeons. 

EDWARD DEL AFIELD, M. D. Professor of Obstetrics, College of Physicians and Surg. 

JOHN TORREY, M. D. Professor of Chemistry, College of Physicians and Surgeons. 

JOHN B. BECK, M. D. Professor of Materia Medica, College of Physicians and Surgeons 

J. C. WARREN, M.D. F.R. S. L. & E. Prof, of Anat. & Surg. Medical School, Boston 

J. REDMAN COXE, M. D. Professor in the Pennsylvania University. 

W. HORNER, M.D. Professor in the Pennsylvania University. 

TH. T. HEWSON, M.D. Professor in the Pennsylvania University. 

S. JACKSON, M. D. Professor in the Pennsylvania University. 

JOSHUA FISHER, M.D. Beverly, Massachusetts. 

Gentlemen, 

My anxious desire is to preserve this work from oblivion. Ushered 
to the world under the auspices of your names, so deservedly conspicuous in 
the republic of medicine, I cannot but fondly cherish the hope, that it will 
receive that attention and patronage to which, from its intrinsic merits, I 
justly believe it entitled. 

Deign, Gentlemen, to accept kindly in the spirit of that enthusiasm which 
venerates genius, the homage of my profound feelings of respect inspired by 
the admiration of your distinguished talents. 

I am, Gentlemen, 
With sentiments of the highest respect, 

Your most obedient humble servant, 

J. F. DANIEL LOBSTEIN. 



Letter from Samuel L. Mitchill, M.D. of New- York to J. F, 
Daniel Lobstein. 

New- York, June 23, 1829= 

My DEAR SiR, 

My curiosity was so excited by the parts of your manuscript 
which I examined on the Semeiology of the Eye, that I have enter- 
tained a desire ever since to peruse it more at length in print. That 
organ is so admirably supplied With blood-vessels, nerves, and mus- 
cles, that it exhibits a remarkable variety of symptoms. Its coats 
and humours give it much additional interest. The eyebrow, eye- 
lash, and the more or less complete function of the lachrymal gland 
afford additional signs for the observer's notice. When its connexion 
with the will, the understanding, and the passions are taken into 
account, there is wide scope given to remark and description. All 
these matters, and more, seem to have been studied by you. When 
the sum of your own inquiries is increased by your profound and 
copious stores from books, I conclude, of course, that the reader will 
find a rich repast for his mind. 

I am glad to learn that the business preparatory to publication is 
progressing so encouragingly, and hope the time is near when the 
opus consummatum will be duly before me. I feel a presage that 
your diligence, judgment, and erudition will be properly appreciated 
and rewarded. 

With much good feeling and many good wishes, I remain, 

Yours, 



SAMUEL L. MITCHILL, 



Letter from Felix Pascalis, M.D. of New- York> to Di% J. F. 
Daniel Lobstein. 

New-York, Jpril 17, 1829. 

My dear Sir, 

I regret your prompt departure from this city, having no time 
to read throughout all your erudite manuscript on the Semeiology of 
the Human Eye. I should say it is classical in its principles and 
references. 

If so much could have been said by poets, physiologists, and other 
physiognomists on the nature of that organ, it is time indeed that 
you and other professional philosophers or physiologists should take 
the subject for their lectures. As for the Lavaterians or physiogno- 
mists, including even Gall and Spurzheim's disciples, I declare they 
cannot do without your work. 

As for the reference of the work to the profession of the law, I must 
say that you are the first physician, to my knowledge, who could 
offer to them some irresistible arguments from the Semeiology of 
the Eye. But they are directed by law : JVimium ne crede colori. 

I congratulate you, dear sir, for having observed and selected such 
a valuable and classical stock of science and knowledge as you have 
done ; whether it is your own or from distant crops and produce, it is 
still the result of your skill, talents, and industry ; and what is more, 
this is a production like aromatic plants and flowers, from which 
buzzing bees can take wax and honey, if they choose, without soiling 
or withering them. I hope that the work may in time contribute 
to your advantage and comfort something more than what is generally 
left as the bare reward of scientific and literary labours, to wit, me 
quoque raptat laudis amor. 

Please to accept, with my best wishes for your health and prospe- 
rity, the assurance of the high regard and esteem in which I remain 
respectfully, 

My dear Sir, your friend, 



FELIX PASCALIS 



CONTENTS. 



Preface, . . . ... . . ix 

Introduction, . . . . . . . xiii 

Semeiology of the Eye, ....... 25 

Expression of the eyes in psychological diseases, . . .41 

Expression of the eyes in fevers, ague, and phlegmasies, . . 46 

Expression of the eye during synocha, . . . . .47 

Expression of the eye in the synochus and its species, . . .54 

Expression of the eye in typhus, . . ' . . .79 

Expression of the eye in the slow fever (typhus mitior.) . . 91 

Expression of the eye in several local inflammations of the organization, 96 
Expression of the eye during an inflammation of the brain, . . 97 

Expression of the eye in inflammation of the lungs, (peripneumonia,) 100 
Expression of the eye in inflammation of the liver, (hepatitis,) . 109 

Expression of the eye in different diseases of the vegetative system, 

presented in an aphoristic manner, .... 120 

Expression of the eye in some diseases in which the sensibility (or ner- 
vous system,) is particularly affected, .... 128 

On the importance of examining the eyes and their expression, in 
medico-legal inquiries ; and on the eyes of accused persons in 
criminal cases, and the expression manifested in their eyes and 
face, . .... . . . . 130 

Description of the eyes, showing the difference between those of a 

woman and those of a man, 139 



V! 



CONTENTS. 



On the effects of different poisons on the eyes, . . . 140 

Description of the eyes, before, during, and after critical periods, . 150 
Important materials for the semeiology of the eye, . . , 152 

The sight, . . . . . 155 * 

Of the eyes and sight, ...... 165 

Of the eyelids, . . . . . . . .168 

Of the parts in the vicinity of the eyes, .... 168 

The lachrymal glands, ...... 168 

The sight, . . . . . . . .169 

Authors referred to in the course of the work, . . . 173 

( 



PREFACE. 



As most authors are accustomed to present to their 
readers a preface explanatory of the motives which have led 
to their respective publications, the author of the present 
work considers himself entitled to the same privilege, and 
avails himself of it, to state, that to the present time, so 
far as he has been informed, no work has appeared in the 
English language which treats explicitly on the Semeiology 
of the eye, at least in a manner so extensive and precise as 
the work which he has now the honour to present to the 
judgment of the scientific public, especially to the learned 
members of the different medical faculties of the United 
States of America, whose literary acquirements and practical 
knowledge, render them equally eminent with the first phy- 
sicians of Europe. 

Professor Loebel, of Jena, acknowledged as one of the 
first physicians of Germany, who, unfortunately, however, 
for the enrichment of medical science, died too soon, pub- 
lished a work entitled : " Ueber die Semiologie des auges, 
zum gebrauch fur aerzte (on the Semeiology of the eye, 
for the use of physicians,) which, in 1818, the author of the 
present publication translated into French. The original 
work was received in Germany with the most marked ap- 
probation, and also in France, where the science of medi- 
cine is cultivated with the liveliest enthusiasm. 

2 



PREFACE. 



The author, tor a period of twenty years, has directed 
his attention particularly to the changes which the eye pre- 
sents, both in sickness and health. His-inquiries were di- 
rected to this subject for some time before the publication of 
Professor Loebel appeared. The author, however, pro- 
poses to embrace in this work the practical observations of 
Professor Loebel, in order that he may pay to the memory 
of this distinguished physician, the merited compliment of 
introducing his useful and interesting labours to the atten- 
tion of the enlightened physicians of this rising republic. 

The present publication may, therefore, be regarded as 
possessing all the valuable practical information embraced 
in the original work of Professor Loebel, confirmed, illus- 
trated, and enlarged by the numerous facts and observa- 
tions derived from the experience of the author. He has 
also been induced to present this work from his firm convic- 
tion of its inestimable value to those gentlemen who are 
deeply interested in questions of jurisprudence, especially 
when he reflects on the success with which the profes- 
sional gentlemen of this country have attempted the 
elucidation of the highly interesting subject of medical 
jurisprudence. He cannot but hope that his labours will 
be duly appreciated and patronised, not only by the mem- 
bers of the medical profession, but also by the justly dis- 
tinguished and enlightened professional gentlemen of the 
bench and the bar, for whose information the nineteenth 
chapter of the present work has been expressly prepared, 
and to w r hose impartial judgment it is freely and confidently 
submitted. 

The author is fully aware, that on many of the topics 
noticed in the introduction, and treated at large in the body 
of the work, much scepticism will prevail, even among the 
most enlightened and meritorious physicians, especially 
those who, heretofore, have not directed their attention to 



PREFACE. 



this highly important subject, and who could not have been 
expected to interest themselves in an inquiry, which, until 
the present moment, had never been presented in the lan- 
guage of their country, and which was scarcely noticed in 
Europe until within a few years past. The author expects 
that his opinions will meet with much opposition, and re- 
ceive their due share of criticism. All that he asks is, that 
his opponents may be influenced by a spirit of amity and 
good feeling, and that their criticisms may be marked by 
candour and impartiality. The judgment of the enlight- 
ened and liberal members of the profession will be respect- 
fully submitted to, and their observations gratefully re- 
ceived. 

For the opinion of those who think themselves capable 
of estimating, and who decide on the merits of a work 
from the mere perusal of its title-page, the author can enter- 
tain but little respect, and to all such he would remark, in 
the language of one of the most distinguished statesmen oi 
this country, " that it is much easier to criticise a large work 
than to write a small one." 

The. author would rather encourage than restrain a free 
and liberal investigation of his opinions. He has'assumed 
to himself the right of presenting his own views to the pub- 
lic, and it is foreign from his wishes to restrain the free ex- 
pression of the opinions of others, should they even be at 
variance with his own. He will cheerfully abandon any 
opinion which may be proved to be erroneous, and will 
gratefully receive instruction when convinced by ample 
evidence of its accuracy. 

The important aphorism of the wise and learned Bacon 
ought to be remembered and cherished by every physician : 

" Non oportet nos ad hserere omnibus quae audimus et 
legimus, sed examinare debemus districtissime sententias 



xii 



PREFACE. 



majorum, ut addamus quae eis defuerunt, et corrigamus, 
quae errata sunt." 

The importance of regarding with strict attention the 
changes which the eye presents in doubtful diseases, is 
amply acknowledged in the writings of the modern as well 
as the ancient pathologists, semeiologists, and therapeutists. 
Wilbrand gives in his Physiology an excellent judgment of 
the imporiance of the eye in diseases when he says : " Non 
seulement l'organe de la vue est par lui meme sujeta une 
foule de maladies, mais le medecin observateur y decouvre 
une infinite de nuances, qui'il reconnoit comme symptomes 
de maladies generates. L'oeil de chaque malade est pour 
le medecin scrutateur, comme pour le moraliste et le philo- 
sophe qui a etudie la nature humaine, un organe bien im- 
portant, que tous les trois doivent observer et etudier avec le 
plus grand soin pour le bien de l'humanite." 

Should this work, as the author humbly trusts it may, be 
found to enlarge the present sphere of medical observation, 
by directing the attention of physicians to new views of 
semeiology, and should it also shed additional light on the 
important department of medical jurisprudence, he will feel 
amply rewarded for his labour. 



THE AUTHOR. 



INTRODUCTION. 



It is in the central organ of the nervous system that in- 
tuition operates in the highest degree ; it is there that the 
soul becomes acquainted with its existence. The optic 
nerves, which receive and conduct impressions made on the 
organ of vision, proceed from the brain, and after having 
reached its base, embrace the peduncle, from which they 
receive some fibrillar, and then direct themselves inwardly. 

The two nerves approach and meet each other upon the 
sella turcica, before the infundibulum, and, by uniting, they 
form a ganglion. The optic nerve becomes round after- 
wards, and takes its direction outside towards the optic 
hole, in which it enters at the base of the eye ; it pierces 
the membranes, and expands itself to form the retina. This 
nervous cup appears to us the true seat of sensibility of the 
eye. We cannot doubt that the membrana hyaloidea, the 
glazed body, the case of the pellucid fluid of the eye, and 
the fluid itself, are endowed with a principle of life, which 
is rendered obvious by motions of contraction and expan- 
sion, and which are, according to chemistry, modified by 
the action of light and the laws of polarity. We observe, 
further, a vital activity in every organ. Why should it not 
be the same in the parts which compose the eye ? It is 
precisely the life of these parts joined to the vital reaction 
of the brain, of the optic nerve, and retina of the eye, 



XIV INTRODUCTION. 

which excites probably in the aqueous humour, and in the 
humour of Morgagni, a certain necessary oscillation, in 
order that the refraction of the luminous rays may operate 
after the same law. 

It is not necessary to observe, that in the act of vision 
the functions of the iris, and other parts of the eye, act 
freely. The motions of contraction and expansion of the 
iris appear to prove it to us, as much by its vitality, as by 
the action of light and the laws of polarity. 

After these data, and especially after observations still 
more exact, we may be able, perhaps, to explain the dilata- 
tion and contraction of the eyeball, a phenomenon which 
depends sometimes on the influence of the mind upon the 
iris, and sometimes on the momentary action of light and 
electricity. 

Vision itself, according to our manner of seeing, can take 
place but by the concurrence of the solid brain, of the optic 
nerve of the eye with all its parts, of the rays of light, of 
exterior objects, and the laws of polarity. The life of the 
brain and eye, with its different parts, can alone give value 
to the laws of optics. In consequence of this, the act of 
vision is at one and the same time a process ideal, real, 
chemical, and mechanical, to which the laws of optics are 
subordinate. 

My readers will do well to compare the remarks em- 
braced in this slight sketch with the observations of the in- 
genious Goethe, Stiffers, Wagner, Hinly, and Troxler. 

In the same respect, and according to the different con- 
ditions required for vision, being more or less realized, 
we see the mimic of the eyes change and express itself dif- 
ferently, as will be noticed more particularly hereafter in 
the semeiology of the eye itself* In addition to the above 
views we shall speak of that intense internal vision or pre- 



INTKODLCTIOA- 



sentiment, which Martin* describes so particularly in his 
account of the Western Islands in 1716. 

It is likely that this interior and spiritual vision is rather 
a sympathetic intuition which exists in nature and appears 
sustained by facts, but which it is impossible to explain by 
philosophical deductions. Before occupying ourselves 
with the expression of the eye, as it is seen by this sort of in- 
spired and exalted visionaries, we will relate some historical 
and incontestable facts on the subject : we shall speak only 
of presentiments and apparitions in the wakeful state of 
persons in good health as well as in sickness. 

A certain Mrs. de Beaumontt relates, in the following 
terms, a very important fact in relation to presentiment : 
" My father had an idea of taking an airing in a boat at 
Rouen : he spoke on this subject to a company, and they 
agreed unanimously to repair on water to Pont-saint-quea., 
four leagues from Rouen. All preparations were already 
made in the boat, and my father got ready to leave his 
room, to repair there, when, on a sudden, one of his aunts? 
who is deaf and dumb, put forth dreadful shrieks, threw 
herself through the party, stopt him in his way in stretching 
out her arms, and made him understand, by very expressive 
gestures, that he should not quit the house this day, nor 
his room. My father laughed at first at my aunt's entreaties, 
but as she threw herself at his feet, and expressed to him by 
signs and extraordinary motions the most profound grief, 
he resolved not to join the party, and endeavoured even in 
a serious manner to dissuade the company from it, at least 
for that day ; but they laughed at him in their turn, and 



* Martin's Description of the Western Islands, 1716. 
f Indem Allgemeinen Magazinder Litteratur und Kunst, 8ter. 
ttS. S. 117. 



xvi 



INTRODUCTION. 



they embarked gaily. However, scarcely had they made 
two leagues, laughing and joking, when the boat dashed 
on a sudden to pieces : many persons of the company 
found their grave in the waves ; the few who escaped fell 
extremely sick through fright, and only remembered after- 
wards this party with horror." 

The psychologists will take no less interest in the presen- 
timent that the prince Frederick Francis of Wolfenbutld 
experienced, in 1758, in the camp of Wissembourg, when 
he foretold to his aid-de-camp, M. de Trusskow, that there 
would be a battle on such a day, and that he (the prince) 
would be killed in it. 

The same happened with the presentiment which Louis 
the XI. had towards the close of his life, namely, that he 
would die on a Saturday. The sequel justified the presen- 
timent, for he died on a Saturday. 

To the presentiment we were just speaking of, is opposed 
that which we observe often during diseases. 

Areteus, the Cappadocean, # says of certain sick persons : 
" their soul is firm, and without the least weakness, their 
senses pure and perfect, their mind penetrating, and disposed 
to foretell. They have not only the presentiment of their 
own death, but they foretell also to the persons present their 
future destiny ; those who did not believe in these predic- 
tions were struck with amazement when they happened. 
This kind of sick persons have even conversations with the 
dead.'" 

Suetonius, f in speaking of Octavius Augustus, informs 
us that his death was mild, but that during his sickness he 
rose on a sudden, complaining that forty young men car- 
ried him away against his will. He was really carried 



* De causis et signis morborum acut. Lib. II. c. 4. 
•j- Indem Leben des Octavius Augustus, cap. 99. 



INTRODUCTION, 



XV 11 



away from his palace by forty men of the imperial 
guard. 

Cicero* cites also an example from Possidonius, where a 
dying visionary foretold to several others their future des- 
tiny, in indicating the order in which several persons pre- 
sent of the same age would die one after the other. 

Meierf relates of Professor Alex. Theoph. Baumgarten, 
from Frankfort on the Oder, that the 25th of May, 1762, 
consequently two days before his death, he said very posi- 
tively that he would die in two days ; but on the day even 
of his prediction he found himself a little better, and when 
his friends showed to him their pleasure at his speedy 
recovery, he said to them : "you are mistaken; believe my 
experience of twelve years, octo dies morior, it is already six 
days that I am dead, there remain yet two to me" He died 
notwithstanding this presentiment, with the greatest serenity 
of mind.J 

We may read several other interesting historical facts of 
this kind, in the works of Venon Seviani, de Jean Nider, 
de Paul Zeising, de Henri de Herr, Michael Alberti and 
Schelwig. 

The learned Professor Loebel, formerly professor of 
medicine at Jena, relates a remarkable example of this kind 
of presentiment in a sick person at Naumburg. A man 
named Huft fell suddenly sick with a gastric fever. He 
sent immediately for his physician, whom he requested to 
visit him very often, but not to prescribe him any medicine, 
since he would die infallibly the eighteenth day of his sick- 
ness. His relations and the doctor endeavoured to dissuade 



* Cicero, de divinat. I, 30. 

f Meiers Leben A. G, Baumgarten, Halle, 1763, S. 27. 
t Kemme von der Heiter Keit desgeistes bey einigen Sterbenden, 
Halle, 1774. 

3 



INTRODUCTION, 



him from this idea, and to act according to the voice of 
reason, but he smiled tranquilly, without changing his opi- 
nion. The seventh day, said Professor Loebel, he was 
called for, and consulted by his wife, besides his attending 
physician. He visited him, and endeavoured to comfort 
him, to inspire him with courage, and to dissuade him from 
the idea of death ; but neither his exhortations, nor those of 
the clergyman, were able to remove this fatal presentiment. 
The tenth he made his will, with much firmness ; he com- 
forted his wife, and recommended to her fortitude of character 
in misfortune ; he called his children around his bed, and 
exhorted them to virtue : after which he awaited quietly for 
the day of his death. To deceive him Professor Loebel 
displaced on his watch the hand which marked the days of 
the month, believing positively that he would not die on 
the fixed day. Professor Loebel went to see him in the 
morning of the eighteenth ; his mind was calm, and he 
spoke to him very reasonably on different subjects, he was 
careful not to mention any thing in relation to his death. 
Professor Loebel took that day a particular interest to 
examine the eyes of the sick person ; he found them bright 
indeed, but having nothing sad nor wild in them ; they had 
something celestial, as if they were already surrounded with 
a bright glory ; the sclerotica was of a dirty yellow, and 
the eyeball sensibly dilated. Towards two o'clock in the 
afternoon, Huft became more uneasy ; he stammered ; at 
three o'clock he told Professor Loebel with firmness and 
smiling — with tranquillity and confidence: "Very soon I 
shall have ceased to suffer ;" and the same day, before sun- 
set, the sick man expired. The opening of the corpse was 
not permitted byhis wife, notwithstanding urgent solicitations* 
These presentiments, as much by persons in health as by 
the sick, appear to us to owe their existence to extraordi- 
nary motions of contraction and expansion in the stratum 



INTRODUCTION, 



xis 



of the optic nerves, and in the optic nerve itself, especially 
before the funnel where the two optic^nerves form a gang- 
lion, and to a certain oscillatory motion of polarity that 
produces a spiritual and intuitive ecstacy, and which creates 
presentiment in certain individuals ; for if we admit that 
the faculties of the soul have their seat in the brain, and 
that is is only there that they can attain the highest degree 
of perfection, and to produce in it a particular intuition, 
why should we not also admit that the faculty of presenti- 
ment and vision exists in the nervous organs of which we 
have spoken ? 

We have been led to this idea by the relation of expan- 
sion and contraction of the eyelids, and especially by a 
somewhat similar manner in the magic expression of the eye 
during the presentiment. Indeed, in the same manner as 
the eyes in their mimic action display by the effect of the 
motions of the soul particular looks determined by the 
oscillations of the brain, in the same manner the eye of a 
visionary ought to represent a subjective image, because it 
exists, and we ought also to admit in the stratum of the op- 
tic nerves, in the optic nerve and in the ganglion, an oscil- 
lation and an extraordinary polarization* Consequently the 
representative faculty, and all which determines the spiritual 
and physical visions and the visions themselves, act upon 
the eye and change the plastic sight, the looks and their 
variations, as we shall show in the course of the work itself 
in a circumstantial and more positive manner. 

The following works may be consulted on the subject of 
presentiment. 

Plutarchus, de defectu oraculorum. Tom. 2. op. p. 196. 
P. Petitus, de sybillis. Lib. I. cap. 8. p. 30. 
A. H. Fasch Diss, de prsedictione mortis. Jen. 1686, 
in 4to. 

Baier Diss, dp praesagiis animi. Jena?, 1699, 



INTRODUCTION, 



Miscellanies collected by John Aubry, id est : miscella- 
nea de singularibus dierum et locorum fatis, ostensis, omi- 
nibus, somniis, visionibus, vocibus ac pulsibus auditis, vati- 
ciniis, miraculis, oraculis, etc. ; collecta A. J. Alberico. 
Lond. 1721, 8vo. 16 b. 

J. J. Sueno Ueber die Ahndungen. Brandenburg, 1759, 
8vo. 8 b. 

Ch. Fr. Eschenbach Obs. de aegro martis diem prsesa- 
giente ; in dessen Observat. anat. chirurg. medico rarior, 
Ed. 7. Alt. Rostock, 1769, 8vo. p. 445—444. 

Ruediger Physic, divin. 1 cap. 4 sec. 4to. 43. 

Spinoza, in Tractat. Theol. Pol. cap. 2. p. 28. 

Ch. Juncker de mortibus ominosis. 

Walch's Philos. Lexicon. Fourth edit. T. 1, S. 160. 

Tr. Hufcland, Ueber Sympathie. Weimar, 1811. in 
8vo. 

We pass in silence the magnetic visions on which Heineke ? 
Kluge, Stieglitz, Eschemayer and others have written a 
great deal, as also the visions in dreams of which Hippo- 
crates, Galen, Tr. Hoffmann, Darwin, Lichtenberg, Unzer, 
Morits, Huber, and others have already taken notice, and 
we shall apply ourselves in preference to consider the eye 
under the physiognomic relation, but briefly. If in reflect- 
ing upon the scientific works of some great men, we find 
that several among them have endeavoured to discover the 
propensity to virtues and vices, as well in the features, as by 
the structure of the skull, and to fix in this respect rules and 
systematical precepts, we must acknowledge that we always 
observed, that these objects have been treated too sepa- 
rately ; since the great and immortal Lavater, as well as 
Doctor Gall, have always attached too much value to the 
distant parts of their object, without embracing the whole, 
and without building their edifice upon the basis of criticism 
and of synthesis. 



INTRODUCTION. 



XXI 



J. Ch. Lichtenberg* says with justice, in speaking of 
Doctor Gall : " We must not treat upon the exterior form 
of a head, in which a soul resides, as upon a pumpion, nor 
pretend to calculate the events which depend on this being, 
as we calculate the eclipses." Let us remark, on the sub- 
ject of the treatise on Physiognomy of Lavater, that this 
author occupies himself not only with the plastic expressions 
which the motions of the soul produce upon the features of 
the face, but that he enters also into some details upon the 
description of the eyes. It appears to us, however, that he 
paid but little attention, and only in passing, to the nature 
and mimic of the eyes. If he had profited by the obser- 
vations of Aristotle, Galen, Poleman, Plinius, Aphrosidius, 
fcr and especially of Porta,f where we find on this subject, 
from page 371 until 447, a treasure of truths, this great 
man would not have treated so briefly of the expression of 
the eyes, and under the consideration only of the history of 
physiognomy. According to our views, we never will be 
able hereafter to establish a scientific physiognomy unless 
we take the eye for a basis, and proceed primitively from 
this organ, connected at the same time with the expression 
of the eye, the description of the face and skull, and judge 
and appreciate these data with a philosophic mind. It is 
only upon these conditions that thinking men will succeed 
in founding and establishing a rational physiognomy. Then 
we shall, without doubt, be convinced that we can recognise 
in some human eyes those of some animals, as, for example, 
the cunning eye of the fox in that of a mischievous man — 
the eye of a sheep in that of a narrow-minded man or a 
simpleton. 



* Ueber Physiogn. in dessen verm. Schrift. 3 B. S. 508o 
f De Human Phys. J. B. Porta. Neap. 1. TV. Uop. 1601. 



xxii 



INTRODUCTION. 



Several ingenious authors have already mentioned in 
their classical works the importance of the eye, considering 
it connected with the expression of the face, and with relation 
to the motions of the mind and character ; such are Galen, 
Plinius, Cicero, Montaigne, Bacon, Haller, Wolff, Gellert, 
and even Lavater. 

The poets, ancient and modern, have always extolled in 
their songs the language of the eyes, and have sought to 
immortalize the eye and its mimic. They seized the beauty 
of the eye, and the soul with its different motions, such as 
it is represented in the eye ; in their enthusiasm they have 
sung the passions in the expression of the eye, and they 
deserved immortal laurels. It is sufficient to name here, 
Homer, Schiller, Goethe, and Sheridan. 

The great plastic artists prove equally by their master- 
pieces, that they have attached the greatest importance to 
representing well the eye, in which we observe the whole of 
their genius. They know how to put a particular expres- 
sion, a true life, into the eyes of their subject, and after 
whole centuries the observer cannot help paying to the au- 
thors a just tribute of admiration. 

To demonstrate this fact, we must mention a rare and 
classical work from Reussner,* in which are inimitable en- 
gravings on wood of the most learned men, poets, philoso- 
phers, and artists of England, Italy, and Germany. There 
reigns an incredible expression in the eyes and physiogno-, 
mies of these portraits. But we invite our readers to exa- 
mine the work in the libraries, and they will convince them- 
selves that these engravings are of a perfection and beauty 



* Icones sive imagines vivse, littcris cl. virorum Italia?, Graecia?, 
Germanise, Galliae, Anglse, Ungarice, ex typis Wald Kirchianis in 
lucem products : cum elogiis variis, per Nicol. Prcussnerum. 'J. C. 
et P. C. Basileie a pud Cour. Waldkircu, mdxic. 



INTRODUCTION. 



XX11I 



little known, and that they answer every thing that can be 
desired from art. 

These excellent engravings on wood have been drawn 
and engraved by Tobie Stimmer. The editor of the 
work makes the following eulogy of them ; " Similis plane 
thesaurus inconum plurimorum, non modo bellica virtuti, 
sed etiam litterarum gloria illustrium virorum, ad vivum 
expressorum in Museo Joviano ad hue cernitur ; ex quarum 
archetypo a nobili artifice Tobia Stimmer summa fide de- 
pictse, et magno studio nec rninare sumptu in publicum pos- 
tea prolatae a Petro Perna, viro optimo et librario diligen- 
tissimo," &c. Particularly are to be admired the expres- 
sion and life that reign in the portrait of Aristotle, the eyes 
of which attest the genius of that great man. 

We remark also in the same work, in respect to the ex- 
pression of the eyes, the portraits of Claude Ptolomea, of 
Alexander the mathematician, of Dante, of Petrarch, of 
Fracastor, Ariosto, Titian, Michael Angelo, and a number 
of others. May the artists who love to reflect, profit by the 
ideas which we display here ! May they study the ancient 
masterpieces of painting with taste and feeling, as objects 
the most important and the most characteristic to form the 
basis of expression and physiognomy ! 



A 



/ 



I 



SJEMEIOLOGY OF THE EYE 



Oulc-e lumen, et delectabile est oculis videre solem.— EccLes. li« 



The eye is undoubtedly the noblest work in 
man, and the finest organ of sense, which being 
destroyed or disturbed, the beauty of the face is 
altered, all its expression lost, and the physical life, 
which is imparted by the soul to the physiognomy, 
as indicated in its various motions and changes, 
becomes extinguished and disappears. 

It is in the eye that the three elements of organi- 
zation unite : the eye may be regarded as the index 
of the feelings of the soul ; it is in the eye that the 
least emotions of the mind, at their beginning and 
maturity, are at every instant perceptible. And this 
important truth will be found confirmed by every 
attentive observer. Wit, reason, genius, thought, 
and sudden ideas, and the lightning of the soul, all 
these intellectual faculties, are they not expressed 
in the eye ? 

Demand of the psychologists, men of extensive 
research and profound thought, if the genius which 

4 



26 SEMEIOLOGY OP THE EYE- 

comprehends every thing, is not easily recognised 
by his looks, and if the treasures of their ideas do 
not display their splendour in this divine organ ? 
Therefore Cicoro says, with as much eloquence as 
truth : " Nihil est difficilius, quam a consuetudine 
« oculorem mentis aciem abducere." It is incon- 
testable that the expression of genius of great men- 
even of those in private life, distinguishes itself 
evidently in the eyes as a gift of heaven. The im- 
mortal Plato appears to have already known the 
radiation of the mind in the eyes : he judges of it 
in the following manner, after the translation of 
Ficinas : 

44 Sed ex omnibus faciei partibus primiluciferi 
4 - oculorum orbes coruscant hac causa dati. Ignis 
44 certe illius, qui non urit quidem, sed illuminando 
- suaviter dieminvehitmundo,participes oculorum 
44 orbes dii fecerunt. Intimum si quidem nostri cor- 
44 poris ignem, hujus ignis germanum sincerumque 
" per oculos emanare voluerunt, in quibus lenis 
44 congestusque ubique ignis hujus modi sit, sed 
46 per eorum duntaxat solidiorem angustamque me- 

dietatem ignis purior evolet, crassior vero cohi- 
44 beatur. Itaque, cum divinum lumen applicat 
44 se visus radio, tunc ea duo inter se similia con- 
44 currentia atque commixta, quo oculorum acies 
i4 diriguntur, ibi in unius jam domestici corporis 
44 cohaerunt speciem ubicunque videlicit tam intimi 
44 quam externi luminis fit concursus. Totum igi- 
44 tur hoc propter siinilitudinem passionem eandem 
* 4 sortitum, cum quid aliud tangit, vel ipsum ab alio 



SEMEXOLGGY OP THE EYE. 



* k tangitur, motum hujus modi ad corpus omne. 
£ perque id ad animam usque diffundens, sensum 
i4 efficit, qui visus vocatur. At postquam in nocteni 
9i discesserit cognatus ignis, visionis radius evanes- 
46 cit" — Plato in Timeo, p. m. 1056. 

In the same manner as the innate force of the 
mind is distinctly to be seen in the eye, so we re- 
mark in it also want and poverty of wit. The eye 
of a man without wit is inanimate. His looks are 
dull and frequently fixed on vacancy ; in one word, 
he is in want of life and animation, therefore Marcus 
Palingine says, with so much force and truth s 

" Has species mente (capitis namque arce suprema 
" Mens habitat solioque sedet regalifer alta) 
u Ostendunt oculi ; nunc prudens ilia sagaxque 
*$ Cognoscit rem, cujus adest formalis imago." 

Here is the place to speak of the effect of the 
affections of the soul, or of the passions upon the 
organ of sight. The passions arise primitively in 
the sensorium commune, and are reflected thence 
in the same moment to the eyes, of which they 
augment or diminish the functions and splendour, 
according as they exert an action more or less en- 
feebled upon the whole organization, or upon its 
parts. 

Joy animates and colours the face, enlivens the 
eyes and renders them bright ; the pulse becomes 
animated ; the heat which the arteries communi- 
cate to all the parts of the body augments ; the 
-prretions become more abundant. Joy displays 



28 



SEMEIOLOGY OF THE EYE. 



itself in the eye by a mild brightness, which spreads 
itself upon the white of the eye and the cornea ; 
and which, by the widening of the iris, occasioned 
by the access of the blood, communicates to the 
eyeball a particular expression, more easy to per- 
ceive than to describe. A divine ray shines in the 
eye animated by joy, and the other parts of the 
face become more expressive. Joy is easily to be 
seen in the eye, and any exact observer will also, 
without much trouble, distinguish in it the inward 
joy or content of the mind. 

Successful love shows itself in the organ of 
sight in a manner very analogous to joy ; it beams 
with mildness, and animates voluptuously the parts 
of this organ ; the iris appears as if dipped in wa- 
ter, rapture is painted on the eyeball, and a volup- 
tuous languour surrounds the cornea of the eye 
and the conjunctiva ; hence it is commonly said of 
these eyes, that they are intoxicated with love (ces 
yeux sont ivres oV amour?) 

We must also mention the language of the eyes 
of lovers, an object worthy of the attention of the 
psychologists. Love that shines in their eyes ex- 
cites the senses, and the sensations which proceed 
from it pass reciprocally from the eyes of one into 
those of the other. They appear, therefore, in 
these moments sometimes full of animation, some- 
times filled with mildness. They look forward, or 
sideways, or fix themselves with ardour upon the 
beloved object ; or as Chrysippus in Plutarch says, 
(de placitis Philos. cap. 15.) "perfundentur ex ocnlo 



SEMEIOLOGY OF THE EYE. 



29 



* radii ignei." Another philosopher describes the 
effects of love in the organization and upon the eye 
in the following manner : 

" Amor vulgaris est fascinatio qusedam. Quid 
44 mirum si patefactus oculus et intentus in aliquem 
44 radiorum suorum aculeos in adstantes oculos 
44 jaculatur, at que etiam cum oculeis istis, qui 

* spirituum vehicula sunt, sanguineum ilium vapo- 
44 rem, quern spiritum nuncupamus, intendit? Hinc 
44 virulentus aculeus transverberat oculos : cumque 
" a corde percutientis mittatur, hominis perculsi 
" praecordia, quasi regimen propriam repetit, cor 
" vulnerat inque ejus duriori dorso hebescit, redit- 
44 que in sanguinem Mars." — Ficinus commentarius 
in Platon. Conviv. cap. IV. 

It is in the eye that love celebrates its triumph, 
and Valloriola, obs. 7, lib. 2, describes admirably 
the loving sympathy of the eyes in these terms : 

" Hie spiritus incensus, et jam amatae rei specie 
" agitatus, cor exagitat, inflammat, uretque nimio 
^ moto atque caloris aestu ; dum vehementer potiri 
64 re amata amans desiderat, dumque vicissim ilia 
" nitentes in ilium oculos convertit, adeoque mutuo 
- adspectu amantes visorios utrinque manantes 
u radios complicant et commiscent annon adspectu 
i4 amatorio praecordia spirituali telo vigent, et una 
" cum adspectu mutuo alter alterius amorem com- 
" bibet?" 

Yes, love has put in the divine organ of the eye, 
the most eloquent and significant expression, which 
all those who in the golden age of life loved, or 



30 



SEMEIOLOGY OF THE EYE. 



were loved, will remember. Unhappy love is not 
less faithfully painted in the eye, but to appreciate 
the expression of this passion in the look, the ob- 
server must also carry his attention upon those 
parts that surround the eyes, an& be capable of 
judging them with these organs. 

The forehead of an unfortunate lover is the seat 
of a particular coldness ; the eyebrows bend 
strongly towards the eye ; sadness and the desire 
of seeing the beloved object renders them heavy : 
the eyelashes are in repose, and turned downwards, 
as if they were the interpreters of the sufferings of 
the soul. Want of hope and regrets are visible 
in the cornea of the eye and the conjunctiva. The 
iris of unfortunate lovers is rather contracted than 
extended, so that the eyebrows appear small rather 
than round and wide. The motions of the eye are 
slow and dejected. 

Let us now examine the plastic representation 
of Chastity. At first, by surprise, which is com- 
monly joined to it, chastity produces an exaltation 
of the vital properties in the organs of the body; 
the blood rushes more towards the breast and the 
face, and hence proceeds the blush which colours 
the cheeks. The eye opens itself and becomes 
larger at first by the effect of surprise, but very 
soon it concenters itself, it bends towards the 
ground, and the eyelashes repose with a mild 
sweetness upon the half opened eye with timidity 
to avoid any further looks. Innocence and modesty 
hover lovingly upon the eye, and establish their 



SEMEIOLOGY OF THE EYE. 



residence in the iris ; and upon the whole physiog- 
nomy they spread an admirable harmony. 

Fear shows itself in the eye in different ways : 
it causes sometimes trouble, illusion, and weak- 
ness : sometimes shivering, trembling of the limbs, 
and palpitations of the heart. One observes, even 
in the eye, inquietude and instability ; it appears 
larger, it moves briskly from one side to the other ; 
the iris offers a tension joined to a reciprocal and 
extraordinary oscillation, fixed looks alternating 
with moveable looks ; the eyeball is rather large 
than contracted ; astonishment, mixed with fright 
and anxiety, is painted in the eyes ; the eyebrows 
are more close than common, and more bent and 
turned towards the eyelashes, and it is with much 
reason that Fromman says on this subject : " In 
44 valescente metu sub palpebris turbidi refugium 
44 quaerunt." 

Affliction and sadness, passions which attack sen- 
sibly moral and physical nature, are recognised in 
the eyes by dejected looks. The eye appears 
troubled, its motions are slow, its looks sad, the 
cornea covered as it were by a cloud, the sclerotica 
is of a watery blue, the eyeball is more extended, 
and the vessels of the iris of a reddish brown co- 
lour. If sadness reaches its height, then we see the 
benevolent crisis of tears. But if sadness passes 
to despair, or to chimerical hope, this struggle of 
the soul manifests itself in the eyes by ferocious 
and convulsive looks, the iris and its vessels be» 



32 



SEMEIOLOGY OF THE EYE, 



come more red, and the sclerotica bright and 
radiant. 

No affection of the soul is more expressed in the 
eye than Anger. It shows itself in it, we might 
say, like an infernal demon ; electric torrents spout 
out from the eyes, which resemble a stormy sky, 
crossed by lightnings, or a hurricane that dashes 
rocks to pieces*, roots out oaks, and spreads fear 
and terror throughout nature. In these fits of an- 
ger the eye sparkles, the humours of the eye ex- 
tend the cornea, a savage fire surrounds the iris, 
the eyeball is more straitened, the sclerotica is 
bright, and its vessels distended with blood. The 
eye seems in this situation willing to devour, to 
crush, or to tear in pieces every thing ; the other 
parts of the face have also the impression of this 
ungovernable passion ; they become red, the lips 
swell, the muscles of the face shrink, and ap- 
pear in convulsions ; the head becomes heated and 
burning. 

Goevres describes perfectly well the effects of 
anger in these terms : 

" Anger makes the lips swell, the eyes sparkle, 
a the face grows red and burning, the lips tremble, 
64 the mouth is inundated by the more abundant 
* 4 secretion of saliva, the heart beats with violence, 
" respiration is accelerated, and the milk of the 
M mother becomes, by the effect of anger, injurious 
• 4 to the child." 

Envy is also a passion which is much seen in the 



SEMEIOLOGY Off THE EYE. 



33; 



eye,.and a passion that manifests itself unhappily 
so often, especially in those persons who do not 
think that the sun shines for every body. Envy 
originates in the imagination or the soul, and ac- 
quires its ripeness in the character ; it attacks pri- 
mitively the sensibility of man, and its dangerous 
effects spread themselves in the second place upon 
the vegetable and irritable systems of the organi- 
zation. Envy is painted round the eyes, and in the 
eyes themselves, as well as upon the whole face,. 
The eyebrows and eyelashes being more contract- 
ed, lose their liberty and moveableness. The eye 
is, so to say, retracted within itself, and fixed to- 
wards the ground ; it cannot support the looks of 
others ; in certain moments it appears to wish to 
rule every thing, and turns sometimes its looks 
freely around, and sometimes regards objects with 
a certain terror. But these symptoms are observ- 
ed only when the envious person has some hope 
that flatters his passion : this moment past, then 
the eye becomes again suspicious, jealous, the eye- 
ball is more closed than extended, and the iris ap- 
pears of a brownish red in black eyes, and of a 
light red in blue eyes. 

These phenomena attest the augmentation of 
the activity of the sanguine system in the iris, an 
activity produced by the fiendish and infernal hu- 
mour that rules the object. The sclerotica is yel- 
lowish, dirty, heavy, and often troubled j thus Pa 
hngene says well : 

5 



34 



SEMEIOLOGY OF THE EYE. 



" Improba pestis 
u Diffundens sese totos contaminat artus, 
" praesertimque oculis angit." 

This envious eye pursues the contented man 
on account of his contentment, the happy man for 
his happiness ; therefore its owner casts but clan- 
destine looks upon other men ; he is gloomy, and 
does not look upon objects with the liberty and 
ease of other men who are happy or given up to 
joy. The reflection of the character admits of no 
dissimulation of the sentiments. Envy shows hell 
in the eye, whilst joy produces the appearance of 
a serene sky. Ovid, the Roman poet, has per- 
fectly well characterized envy in the following 5 
verses : 

" Pallor in ore sedet, macies in corpore toto ; 
" Nusquam recta acies ; livent rubigine dentes r 
" Pectora felle virent, lingua est suffusa veneno ; 
" Risus abest, nisi quern visi movere dolores : 
" Nec fruitur somno, vigilantibus excita curis ; 
" Sed videt ingratos, intabescitque videndo 
" Successus hominum," 

The picture which we have just presented of the 
eye of the envious, displays these hideous features 
only when the passion lords it absolutely over rea- 
son, and when it becomes the constant, predomi- 
nant, and habitual disposition of the character ; in 
other cases it shows itself but lightly, and in cer- 
tain circumstances of life, its expression is not so- 



SEMEIOLOGY OF THE EYE. 



35 



remarkable in the organ of the sight ; for then, 
reason preserving its free course, it is possible that 
this passion may be excited by just and reasonable 
motives, and govern, accidentally the man over 
whom reason has the greatest power. Let us en- 
deavour to establish the fact by an example. If an 
enlightened man, and friend of his country and the 
people, discovers a scholastic writer of an exalted 
mind, who attacks the rights of the people, and even 
their individual liberty, by deceitful sophisms, or 
who. on account of their religious or political opi- 
nions, wishes to strike them out of the list of na- 
tions, if, I say, a man of wit will rise against such 
a fanatic, and refute his anti-philosophical princi- 
ples by reasons drawn from natural right, and he 
sees himself anticipated by another philosopher in 
defence of the imprescriptible rights of the peo- 
ple, if then he feels rise in his heart some emotions 
of envy to have been deprived of the opportunity 
to speak in such a noble cause ; beware to con- 
found this virtuous envy with the criminal envy we 
have described, and which paints itself in so strik- 
ing a manner in the eyes. It appears that De- 
mosthenes in his oration for Ctesiphontes had that 
meaning when he says : " Quis omnium mortalium 
44 nescit, vivos omnes invidia aliqua laborare, alios 
44 majore, alios minore ?" 

The affections of the soul, and the practice of 
virtuous or criminal actions, are also in a very os- 
tensible manner expressed in the sight. The rob- 
ber and assassin display in their eyes the habit of 



36 



SEMEIOLOGY OF THE EYE. 



crime. Misanthropy is naturally imprinted in the 
eyes of a tyrant, and a bad conscience is visibly 
expressed in this organ. Such an eye casts but 
gloomy and clandestine looks around, and no dis- 
simulation succeeds in converting the looks of a 
tyrant into those of benevolence and liberty ; for 
the predominance of the ill over the good reap- 
pears involuntarily in the eye, and announces crime 
and perversity. The expression of the soul in the 
eyes is perfectly well described by these verses of 
Palingene i 

u Mitto ea, quae faciunt homines, quae lingua referre 
" Nulla potest ; ergo hie sensus pulcherrimus atque 
" Optimus est, in quo sedes pene creditur esse 
" Praecipuumque animi hospicium ; quotiesque videre 
u Aut affari aliquem volumus, turn lumina nostra 
1{ Ejus in adversos oculos intendimus, ac si 
" Totus homo atque animus totus consideret illis. 
" Nempe oculos, animi speculum, quicunque vocarit> 
" Verus erit : nam blandus amor lucescit in illis ; 
" Apparentque odium, Veritas, dementia, mceror, 
" Laetitia, improbitas, pietas, prudentia, nec non 
;£ Stultitia, ambitio, timor, ira, audacia, culpa." 

Every epoch of life offers also in the eyes a par- 
ticular inclination of the mind or character. It is 
thus we see in the eye of a child, innocence, in- 
genuousness, mildness, and sweetness of temper. 
In youth and manhood, liberty of mind, and the 
passion of life and love are there expressed. In 
manly age, we can read in it, force, seriousness*, 
perseverance, love to one's country, enthusiasm 



SEMEIOLOGY OF THE EYE. 



37 



and energy ; the eyes announce the experience of 
the instability of human actions. The cornea of 
the eye is more hard and less bright than in the 
eye of manhood, the border of the iris, which it 
connected to the cornea and the skin of the eyelid 
by a single and very fine tissue, often of a milk-blue 
colour, and the interior border that forms the apple 
of the eye, is of a red more or less dark. 

Even the outlines of the ages of life, can be ob- 
served in an analogous manner in the eyes, as 
spring, summer, autumn, and winter in eternal and 
infinite nature. 

The sympathy and antipathy, or the idiosyncrasy 
of the eye, in respect to certain colours, ought also 
to fix our attention. In the same manner that there 
exist a certain sympathy and idiosyncrasy in the 
character, we observe also in the eye affection or 
aversion for certain colours. The ingenious Fra- 
castor says very well on this subject : 

" Mira profecto ea concordia est, quae inter 
" sensus et eorum objecta versatur, si temperata 
" sint; alioqui, si excedant, non solum non con- 
" sentiant cum sensitoriis, sed ea perturbent et 
" corrumpant." 

He continues in this sense, and after having 
spoken of sympathy and antipathy of the sound 
and tones of the voice, he comes to the eye, of 
which he treats in these terms : 

" Eadam et circa visum contingunt, et prop- 
%i ter easdem causas. Lumen enim si ingens sit, 
■f ab anima ferri non potest quoniam et ipsam vir- 



38 



SEMEIOLOGY OF THE EYE. 



44 tutem et applicationem dissipat, quod et colores 
" quoque faciunt, qui nimium lucis habent, ut albi 
" et rubri, si et fulgidi sint; medii vero, quod tem- 
44 peratiores sint, grati omnes recipiuntur, et inter 
44 ipsos viridis qui temperantissimus est, turn qui 
44 illi sunt proximi ut puniceus et flavus. Niger 
44 vero, quod privatio quaedam sit lucis, minus de- 
44 lectat ; parvorum quoque conspectus ingratus 
44 pariter est, quod applicatiohe multa indiget et in- 
4 * distinctus est."-— 'J^e S&nsuum sympathia et antipa- 
thia, p. 83—84. 

The first cause of sympathy and antipathy in 
the senses, and especially in the eye, is not very 
easy to describe, nor the sympathy and antipathy 
of characters; but experience has nevertheless 
convinced us, that these phenomena exist in the 
organization, and that they are very important for 
the naturalist, physiologist, and physician in dis- 
eases. 

Martial in one of his epigrams, (Lib. I. epigr. 
2.) says: 

" Non amo te, Sabidi, nec possum dicere, quare ; 
" Hoc tantum possum dicere : non amo te." 

It is not only in individuals, that the eyes may 
be considered as the mirror of the soul and charac- 
ter, but these organs show most generally the spirit 
and character of whole nations. We distinguish in 
it liberty and slavery, happiness and misfortune, 
wealth and poverty. Examine with coolness and 
attention the eyes of unfortunate people, who are 



SEMEIOLOGY OF THE EYE. 



39 



obliged to spend a miserable life in slavery ; whose 
cruel destiny does not allow them to contemplate 
and to admire the beauties of nature, and to whom 
spring and summer are without charms. Every 
morning that the sun embellishes only adds to their 
misery; days appear to them too long, because 
life is odious; oppressive burdens, imposts of all 
kinds, and restriction of liberty, deprive them of 
all the enjoyments of life, and subject their children 
to the most urgent wants; vampires in human 
shape, miserable flatterers of the great and power- 
ful, sport with their legitimate hereditary properties, 
and annihilate their physical and moral strength, 
by arbitrary and tyrannical acts. You will find 
those people's inanimate eyes having the impres- 
sion of misfortune, grief, trouble, malediction, 
fury and despair painted on them ; their eyebrows 
are puckered by the thirst of revenge ; their looks 
are mistrusting, gloomy, ferocious, and furious. 
What a different aspect the impression of the soul 
and character offers in the eyes of the people of 
free nations ! Look at the independent and happy 
nation of the United States of America, where every 
citizen enjoys equal rights ; where there exist nei- 
ther ranks nor religious privileges: look at the 
countries where the people are animated by the 
love of labour, order, and industry; where wealth 
and love for science and the arts reign, which can 
attain their last degree of perfection only in free 
nations. Happiness and joy are visible in their 
eyes; their looks are open, agreeable, affable 



40 



SEMEIOLOGY OF THE EYE. 



grand, and noble ; we discover in them force, life, 
energy, perseverance, and candour. Here we do 
not perceive the gloomy and hidden eye of a 
Philip II. nor the frightful and ferocious features of 
a Nero and Caligula. The looks of the inhabi- 
tants of North America announce the sweet senti- 
ment of liberty, which Palingene celebrates in the 
following verses : 

" O bona libertas, pretio pretiosior omni ! 

O summura primumque decus, qua prorsus ademta 
" Nil gratum, nil dulce viris, et vivere mors est!" 

After having treated of the psychological and 
physiological semeiology of the eye, let us pass to 
the pathological semeiology, in which we shall en- 
deavour to indicate the symptomatic phenomena 
of interior diseases in respect to that organ, which 
will enable us to see of what importance is the 
splendour of the eye, and to discover its diagnos- 
tic and prognostic pathology. 

In diseases the eye announces life and death, 
therefore the skilful and enlightened physician on 
entering the room of the sick begins to look at his 
eyes ; he examines them, observes them with the 
greatest attention, and deduces from them with an 
admirable precision the diagnostic and the prog- 
nostic. We ourself have acquired a certain ex- 
perience in the art of reading the eyes, but we 
would endeavour in vain to reduce it to established 
rules. The philosopher, can he transfer to the 



SEMEIOLGGY OF T&E EYE. 41 



mind of his scholars his ideas, the result of his own 
conception ? Genius conceives it, but cannot 
teach it. It is the same with the medical presen- 
timent, and with the faculty to employ it as to phy- 
sic, personal qualities which are not possible to be 
communicated to students. We teach indeed phy- 
sic in our colleges, but it is impossible for us to 
teach tact and genius ; these gifts are innate, and 
God alone can produce them. 

It results from what we have just said, that the 
pulse, the periphery of the skin, the secretions and 
excretions cannot be justly appreciated in diseases, 
without taking at the same time into consideration 
the different symptoms which the eyes present. It 
is only in submitting the eyes in diseases to the 
same examination we use to investigate other 
parts of the body, that our researches will become 
important and fruitful. 

We shall also endeavour in this work to com- 
municate to practitioners our experience upon this 
subject, and to draw their attention to an organ 
which is of so high importance in all diseases. 

Expression of the eyes in psychological diseases. 

We have already spoken of the importance of 
the observation of the eye in persons in good 
health : we have shown that not only perspicacity, 
reason, genius, judgment, and all the faculties of 
the soul are traced in the eye, but that we discover 
in it also the opposite qualities, as simplicity, 

6 



42 



SEMEIOLOGY OF THE EYE. 



mediocrity or want of wit. It is particularly in the 
disorders of the intellectual faculties where there 
exists often an idiopathic vice of the brain, or of 
the nervous system, that the eyes show us clearly 
what passes in the interior of the person. 

I have remarked several times myself, that in- 
sane persons after their cure have, for a long time* 
something savage and timid in their eyes: they 
had a certain equivocal air, in a word, indicating 
incontestably that the functions of the mind had 
been deranged and troubled. 

The eye of a person whose mind is deranged, is 
& true mirror for the physician versed in diagnosis 
and prognosis. Thus Gmelin says justly in his 
General Pathology, p. 174 — 175 : 

" Among the most constant phenomena we must 
w count a deranged look, and which is in some 
4i manner the mirror of the soul. The eyes roll 
44 sometimes in a ferocious manner; at other times 
;i they are fixed with sullenness on the same point, 
i; or appear troubled and dejected, or entirely dull 
44 and without expression." 

In simpletons the weakness of understanding is 
very prominent in the eyes, and is to be observed 
at the very first sight. The eye of the simpleton 
is without animation and petrified ; his looks are 
dejected and fixed forwards, and only the instinct 
of nourishment gives them the impression of an 
animal motion. It is almost needless to add, thai 
at the same time his mouth is gaping, his arms 
hanginsf, and his knees bent, and that in general 



SEMEIOLOGY OP THE EYE. 



43 



the vital motions are slow and inert. His eyes in- 
dicate an affection of the brain, which proceeds 
from a dynamical or chemical disproportion, or of 
a vicious organization of the brain, but the imbeci- 
lity of the eye always announces that of the mind, 
whose image is represented in it 

In the fool, or in folly (mon«,) the unorganized 
succession of ideas is faithfully expressed, and his 
extravagant intentions are visible in his inconstant 
looks. If in folly he imagines himself a sovereign, 
emperor or king, his eye is shining with felicity and 
satisfaction, and he casts a look of contempt 
around him. If by chance he imagines himself 
loved by a princess, one sees shine in his eyes en- 
thusiasm, benevolence, and happiness ; an extraor- 
dinary brightness is spread upon the albuginea 
and cornea. 

On the other hand, the eye of a melancholy 
person deserves also your attention ; it announces 
misanthropy, taciturnity, and discouragement : one 
discovers in it the impossibility of attaining a 
proposed end, a gloomy meditation, an extreme 
insensibility for exterior objects, sorrow and mis- 
fortune. 

If mysticism or religious fanaticism occasions 
melancholy, we remark commonly extravagance 
and reverie in the mysterious and extraordinary 
looks which their subject casts around him. The 
upper eyelids bend down and repose upon the eye 
like a person that is tormented by a violent de- 
sire. 



IJ 



SEMEIOLOGY OF THE EYE. 



In fury or madness, which indicates a morbific 
ferocity of the faculties of the mind, and a force 
of imagination truly ungovernable, which produces 
a warm oscillation in the brain, and displays itself 
by violent actions, the eye casts irregular, fierce, 
and confused looks, so that the eyes of the maniac 
resemble the ferocious and sparkling eyes of the 
man in anger, with this difference, that the pheno- 
mena of anger are but temporary, whilst those 
peculiar to the maniac are more durable, because 
the disorder of the mind, which has become a 
mental sickness, is permanent and fixed in the 
looks of the furious. It is especially during a fit 
that the eyes of the maniac sparkle with most 
fury. 

The gloomy and squint-eyed looks of the maniac 
indicate a new fit of sickness. I have often, in 
my practice, made the important observation, that 
in the intervals the maniac spoke with an apparent 
calmness, and seemed to wish to overpower the 
explosion of their fury by a feigned mildness, but 
the eye betraying the confusion of the mind, an- 
nounced by its strabismus and savage looks the 
approaching fit of madness. 

In these circumstances the eye has always been 
our most infallible and most certain guide. As the 
disorders of the mind are seen to display them- 
selves in the eye, the attentive observer may also 
remark there any feebleness of perception, or re- 
markable deficiency in the intellectual faculties 



SEMEIOLOGY OF THE EYE. 



45 



In these circumstances the eye has always been 
our surest and most infallible guide. 

Feebleness of intellect (amentia) or the diminu- 
tion of the superior faculties of the understandings 
is to be seen in the eye by a look which appears 
unsteady and without any interest. The eyeball is 
large and rather round than contracted. In weak- 
ness of memory {amnesia) the eyes disclose a cer- 
tain effeminacy, an irresolution and an insensibi- 
lity, so that we may at the very first moment, with 
a little practice, find out the sickness. This obser- 
vation is very often confirmed by people of a very 
profound knowledge, who after having studied much 
in their youth, reach a very great age. These in- 
dividuals, towards the end of their life, are fre- 
quently subject to weakness of memory and reason. 
The imperfection of our being, and the impre- 
scriptible laws of nature become perceptible, and 
this unhappy effect is rendered very obvious by the 
phenomena we were just speaking of. Therefore 
Seneca remarks with justice : 

" Prima languescit senum 
" Memoria, longo lassa sublabens situ."* 

Seneca in (Edipo. 

After having rapidly traced the picture of the 
alterations which the eyes present in physical dis- 
eases, we pass to the symptomatic changes in 
these organs during physical and acute diseases, 
and we shall make known the important, discove- 



46 



SEMEIOLOGY OF THE EYE. 



ries which the great masters of the art have taught 
us. We shall add, at the same time, with more 
exactness, and in a more precise manner, the ob- 
servations we have collected in the field of experi- 
ence, hoping to offer thus to practising physicians 
a useful labour, and one from which they may reap 
some advantage, as far as regards diagnosis and 
prognosis. 

Expression of the eyes in fevers^ ague> and phleg- 
masies. 

In the same manner as the phenomena of the 
pulse and the urine taken separately, do not autho- 
rise the physician to give his decided opinion of a 
disease, and as he ought to take into consideration 
the other phenomena which occur in the organiza- 
tion of the sick, to draw any results from them, in 
the same manner he ought not to consider altoge- 
ther the changes of the eyes, as the only proper 
signs of diseases ; but he ought to take notice of 
the other phenomena of the organization, compare 
them with the aspect of the eye, and deduce from 
them his diagnosis and prognosis; for circumstances 
change the state of things, and partial observations 
lead to false judgments which may jeopardize the 
life of the sick. 

According as one or the other of the systems of 
the organization is especially affected with fever, 
and as this affection attacks at the same time 



SEMEIOLOGY OP THE EYE. 



47 



syiaptomatically the whole body, this pre-eminence 
of the system will be more or less visible in the 
eyes ; for the three systems of the organization, 
sensibility, irritability, and vegetation are represented 
in this noble organ. 

These systems perform an important part in 
diseases at that point where the symptomatic may 
become an idiopathic affection. 

Expression of the eye during synocha. 

We are going to trace at first a faithful image 
of the phenomena which the eye exhibits to us in 
synocha, in order to be able to seize and distinguish 
the differences which the eye presents in other 
sorts of fevers. The inflammatory fever, properly 
called synocha, in which the action of the irritable 
system is augmented, and where there is tendency 
towards the coagulation of the blood, (which 
announces generally an exaltation of the vital 
forces,) is obvious from a splendour and particular 
lustre of the eyes. During the increase of the fe- 
ver they are red ; the sclerotica is rather reddish 
than humid. In this sort of fever we have found 
the eyeball rather straitened than dilated, and the 
vessels of the border of the iris that form the eye- 
ball, were, especially in the most dangerous mo- 
ments of this inflammatory fever, more swelled, 
and of a more brownish red than in other inflam- 
matory fevers 



48 



SEMEIOLOGY OF THE EYE. 



In treating above of the phenomena of the eye 
in disorders of the mind, we have not thought pro- 
per to make an enumeration of the other morbific 
phenomena of the organization ; but we think, that 
in offering the expression of the eyes in fevers, it is 
important to indicate the other phenomena peculiar 
to each sort of fever, in order to be able to seize 
and distinguish better the essential differences of 
each individual fever. The inflammatory fever 
appears commonly during the north winds, or east 
winds in winter, when the air is dry and cold, and 
it attacks in preference strong, robust, and ple- 
thoric men. It announces itself at first by a vio- 
lent shivering, followed by a continued heat : the 
pulse is full, strong, augmented, and hard, and re- 
sembles when one touches it, a cord stretched and 
in vibration. 

The face is much coloured, and often so red, 
that there are every where effusions of blood under 
the skin ; if we touch the skin it is not warmer 
than common; it appears rather, on the contrary, 
of a mild temperature. The eyelids are painful ; 
we have often found them stretched and very warm 
on touching them. The patient is deprived of the 
sense of smell ; his tongue is hot, red, or covered 
with some whitish strixa of clay. Besides, there is 
connected with it an oppressive and burning head- 
ache, sometimes a delirium, the mouth and the lips 
are dry and warm, and thirst in these fevers is very 
strong and almost unquenchable. Sleep is inter- 
rupted or fails entirely. The stools are hard, rare, 



SEMEIOLOGY OF THE EYE. 



49 



and of a brown or red colour : the urine passes 
with pain, and often causes to the sick at its pas- 
sage a feeling of burning in the urethra ; it is of a 
dark red, inflamed, or of a brick colour, and at the 
beginning of the fever it is clear, and has a depo- 
sit. Without being constrained, respiration is fre- 
quent and great, the exhaled air is warm, and has 
a smell similar to the breath of persons who are 
fasting. The blood drawn from a vein is covered 
with a thick skin with little serosity. The transpi- 
ration is suppressed, and the periphery of the skin 
is dry and without exhalations. The feverish 
heat augments progressively, especially towards 
evening and during the night ; it diminishes after 
midnight and towards morning. We remark at 
the same time in impatient sick persons, and espe- 
cially children, a disorder in the nervous system, 
with subsultus tendinum, convulsive motions and 
oscillations in the nerves \ when these symptoms 
complicate the fever, the eye appears ferocious 
and sparkling, darting lightning around it : if we 
approach the patient with a lighted candle, the 
eyes cannot bear the splendour of the light. They 
are extremely sensible and disturbed. In this pri- 
mitive fever, impatience and anger predominate in 
the eye. 

The observer will undoubtedly find in nature at 
the bed of the sick, the phenomena we have traced 
in this sketch. But if there occurs a salutary cri- 
sis, the eyes become more calm, the looks cease 
to be inflamed and troubled, the redness of the 

7 



50 



SEMEIOLOGY OF THE EYE. 



sclerotica changes gradually into a fine white mild- 
ness, and effeminacy reappears in the eye, so that 
the skilful physician sees at his very entry into the 
room of the patient, according to the state of the 
eyes of the latter, that the sickness has changed, 
and that he is better. This calm in the eye is com- 
monly accompanied with a diminution of the 
greatest part of other tempestuous phenomena of 
the fever, and the physician ought, at the same 
time, to take due notice of it. 

But if the crisis of the synochus is imperfect* 
or incomplete, the eye preserves always something 
bright, and if we compare the critical secretions 
with the violence of the inflammatory fever which 
exists, with the pulse, heat, thirst, and the other 
phenomena of the sickness, we are soon convinced 
of the imperfection of the crisis, and we ought, 
according to these diagnostic signs, to regulate the 
antiphlogistic treatment. 

In a similar catastrophe of the fever, the eyes 
of the patient will deceive you ; we always have 
found in it the truth of the axiom : " Nullum pau- 
" cum criticum." If the synochus augments and 
the patient becomes delirious, a change we have 
had occasion to observe several times in our prac- 
tice, the eyes present a more ferocious and spark- 
ling appearance than in a common idiopathic in- 
flammation of the brain. But if the inflammatory 
synochus passes into putrid synocha, the stomach 
becomes deranged, and then the eye appears spark- 
ling, but not with so dark a rod as in the first case; 



SBMEIOLOGY OF THE EYE= 



51 



on the contrary, the sclerotica is a little yellow, 
sometimes even of a dirty yellow, and the eye ap- 
pears fatigued and aqueous. The description of 
the eye enables us to decide with accuracy on the 
abatement of the fever, or inflammatory symptoms. 
If the synocha passes to suppuration, the face be- 
comes of a darkish red, the eyes sparkle, the pulse 
is full and soft, the red colour of the urine very 
soon disappears, the skin becomes moist and is 
covered with a clammy sweat, while the patient is 
at the same time affected with shiverings. 

The patient complains often of a coldness which 
descends along his back ; the head is inclined on 
the chest and the face turns pale ; the eyes are 
hollow, and appear to be deeply concealed in the 
orbits ; they resemble exactly those of a person 
attacked with an inveterate gonorrhoea : they are 
more aqueous and brilliant than common ; blueish 
circles form under the eyes, coughing takes place, 
and sudden flushes often appear on the cheeks* 
These phenomena show us the beginning of the 
formation of matter in the lungs. The tongue is 
at the same time white, slimy, and humid ; the lips 
are also humid, and of a pale red. The pulse is 
undulating and frequent, or slow and inconstant ; 
the urine is of a light yellow or dark red, and pre- 
sents a thick and slimy sediment. 

If the synocha passes from the synochus to ty- 
phus, and if the inflammation of the system attacks 
with violence the organic structures, it does not 
terminate by resolution, or by other critical motions. 



;>2 



SEMEIOLOGY OF THE EYE. 



but by induration ; the eyes present precisely the 
same appearance as when inward scirrhosities 
exist ; the patient appears to be suffer ing, and pre- 
sents the same expression as those persons who 
are labouring under mental anxiety from pain or 
sorrow. The complexion is of a dirty aspect ; the 
face exhibits marks of pain. We see further around 
the angles of the mouth a particular feature, which 
appears to reveal a badly concealed pain, like some 
person who has a secret trouble, which he wishes 
to disguise under an air of contentment. In these 
persons we have always remarked the same feature 
around the angles of the mouth. 

Finally, if the synochus terminates in typhus 
fever immediately, or passing at first to the syno- 
cha, and it attacks the sphere of the sensible sys- 
tem, then gangrene often takes place. 

This gangrene shows itself at first by a total 
change of the humour and character of the patient: 
the skin is commonly covered with a clammy sweat, 
the voice becomes trembling, the face appears ex- 
tremely gay or extraordinarily serious. The pulse 
is, at first, very regular, but always more frequent, 
without ever being full ; afterwards it becomes slow 
and scarcely perceptible. 

The patient has great pain, uneasiness, and 
wishes every moment to change his place ; the urine 
is of a dark brown or yellow, with a milk blue 
border ; it is thick and exhales a bad smell. It is 
in these moments that the eye offers a particular 
and celestial splendour, as if it would announce 



^EMEIOLOGY OP THE EYE. 



53 



the approaching end of man. The iris and the 
sclerotica have something particularly significant, 
which, without doubt, any skilful physician will 
have remarked in the diagnosis, as well as we, if 
he has paid but a slight attention to the eyes of a 
patient attacked with gangrene. 

It is indeed impossible to trace here with exact- 
ness the description of the phenomena in the eye ; 
those who have seen it by experience will agree 
with us in sentiment. The celebrated Assalini 
draws also our attention, in a very instructive man- 
ner, to the important and extraordinary refractions 
of the luminous rays of the eyes of persons attacked 
with gangrene. The shining eye preserves its 
brightness until the extinction of life itself. 

It is almost useless to remark, that at the same 
time the extremities are cold, and announce ap- 
proaching death. However important the plastic 
semeiology of the eye in the synochus may be, it is 
not less so in the synocha. This last fever, which, 
according to the experience of our celebrated prac- 
titioners, Marcus and P. Franck, has its primitive 
seat in the vegetable organization, and as we have 
exactly found it in clinical practice (for the skin, 
the intestinal canal, and the organs of vision, play 
the principal part,) this fever, we say, impresses its 
changes and its specific gradations on the eye 
equally as in the former case. It is to this that 
the practitioner ought to direct a particular atten- 
tion, and join to it the other pathognomonic symp- 
toms, for he who does not know how to appreciate 



54 



SEMEIOLOGY OF THE EYE. 



well the changes of the eye in the synochus, will 
never be able to judge of its very frequent compli- 
cations with gastric disorder, and the affections of 
the liver connected with it. 

If the synochus does not arise secondarily from 
the synocha, but begins primitively, it declares 
itself commonly in summer, especially during west 
winds or warm rains; sometimes also, but very 
rarely, it shows itself in winter during the rainy 
weather. 

Expression of the eye in the synochus and its 
species. 

In order to comprehend better what we are going 
to explain, we shall observe, that we understand 
here by the word synochus, that kind of fever which 
the practitioners designate under the different 
names of synochus putris, febris remittens, biliosa 
inflammatoria, febris biliosa putrida, febris cum 
colluvie pituitse in primis viis, febris asthenica, feb- 
ris verminosa, febris pituitosa, fievres gastriques, 
bilieuses et putrides. 

This fever takes its character from the causes 
which produce it. It resides, however, in the ve- 
nous system, let it proceed from what cause it may. 
It presents, in the first instance, violent inflamma- 
tory symptoms ; but according as the principal of 
life is attacked in the organization, the inflamma- 
tory period exists several days, especially during 



SEMEIOLOGY OF THE EYE. 55 

the time when the fever inclines towards the ner- 
vous, or towards the inflammatory fever. If, on 
the contrary, it inclines towards the putrid fever, 
the inflammatory period lasts but one day, or is 
generally but of a very short duration, for then the 
sickness appears, by the progressive display of the 
chemical action, to suppress and subdue promptly 
the vital strength in the organization, in one word 9 
then, the chemical dissolution prevails over the pre- 
servation of life. 

If, in the synochus, the pulse is hard, full, and 
soft, it is wavering and feeble in the synpcha, and 
is very compressible under the finger, especially if 
the fever manifests itself without a gastric disorder, 
which happens very seldom. It is true, that the 
eye appears in this kind of synochus a little inflam- 
ed, but not with a sparkling red : it does not re- 
main constantly so, for in the moments of relaxa- 
tion, it is rather more dull and aqueous than in- 
flamed, and at this period the eye in this fever 
continues changeable, and distinguishes itself from 
the expression of the eye in the synocha. 

Let us remark besides, that the synocha appears 
with the rapidity of lightning without any previous 
complaint, whilst, on the contrary, the synochus is 
always preceded by certain pains. The patient 
feels weak, his appetite diminishes, his eye, before 
the eruption of the fever is abated, is sad, and his 
looks gloomy ; the bad humour of the patient is 
painted in the eye ; it is surrounded with a small 
blueish circle. One cannot help observing in the 



SEMEIOLOGY OF THE EYE. 



patient a kind of weakness, a certain sign of the 
synochus, and which will always accompany this 
sickness. 

When the sickness inclines more to the synocha. 
the aspect of the eye, in the first period, is rather 
glazed than inflamed, and afterwards sparkling; 
the skin is very dry, or excessively moist, and the 
pulse has not the undulation or characteristic soft- 
ness, but is quick and frequent. The urine is tur- 
bid, yet oftener of a yellowish white. 

When the synochus manifests itself, the shivering 
is less obvious, less permanent, and at that period 
also the eye is less dry and shining, than in the 
synocha, but it is more aqueous, as if the patient 
had exposed his eyes to a sudden current of cold 
air. These symptoms are commonly accompanied 
with a blueish circle round the eyes, or with a little 
visible swelling of the lachrymal bag, similar to 
that which we observe so often in persons attacked 
with dropsy of the chest. 

As the simple synocha is a continued, and the 
simple synochus a remittent fever, the expression 
of the eye offers different aspects in the abatement 
and exacerbation of the latter. During the abate- 
ment of the fever the eye is more dull and aqueous. 
We remark here and there greasy spots in the 
sclerotica ; the iris is a little pressed, whilst during 
the exacerbation the eye is more sprightly and the 
iris more raised. 

If gastric disorder has preceded the syno- 
chus, the sclerotica appears from the very begin- 



SEMEIOLOGY OF THE EYE. 



57 



ning of a dirty yellow; but in the contrary case, it 
remains white, and contracts this dirty yellow co- 
lour in the course of the sickness, when the gastric 
disorder supervenes on the synochus. Moreover, 
the appetite disappears totally. The tongue is 
covered with a yellow or white fur or coat, the 
mouth is clammy, and the patients complain of an 
acid, bitter, sweet, or putrid taste. They experi- 
ence a kind of plenitude in the pit of the stomach, 
qualms, a desire to vomit, and even vomitings; 
their complexion is yellowish, or in fat persons of 
a dark red ; the heat is burning, and is especially 
felt in a very disagreeable manner in the hollow of 
the hands during the exacerbation. 

At the beginning of the synochus, the urine is 
very red, afterwards it becomes turbid, clammy, and 
on being placed in a glass we may observe it disen- 
gage small white globules ; the stools are disco- 
loured and sometimes of a light brown. 

All kinds of gastric fevers, the inflammatory 
bilious, the putrid bilious, as well as the pituitous 
fevers, are painted in the eye in a manner difficult 
to be mistaken, and pronounce themselves especi- 
ally in the sclerotica. The character of the fever 
may be determined as much by the constitution of 
the patient, as by the morbific influences which 
occasion these kinds of fevers. 

He who desires to have a particular knowledge 
of the gradations of these fevers, and particularly 
of the hot fever, must consult the excellent works 

8 



58 



SEMEIOLOGY OF THE EYE, 



of Stoll, of Quarin, of Peter Frank, and of Rich- 
ter. 

The hot fever is a continued remittent fever, 
which manifests itself generally in spring, in young 
and robust persons, and which distinguishes itself 
by a burning heat, by an unquenchable thirst, by 
dryness of the skin, by the difficulty of respiration, 
by urine of a dark red, by an undulating pulse, which 
becomes hard at the moment of the exacerbation, 
and by gastric symptoms. 

The saburral fever may, at least in the first pe- 
riod, appear with an inflammatory complication. 
Whether this fever proceeds directly from an excess 
in undigested aliments, or results from the produce 
of the morbific secretions from the stomach, from 
the intestinal canal, or from the liver : when slimy 
matter or bile gathers in the first instance, we per- 
ceive constantly the change of the eyes, independ- 
ently of other mobific phenomena. These pheno- 
mena are : want of appetite, disgust for aliments, 
especially for meat, vomitings of all kinds, oppres- 
sion in the stomach and in the breast, headaches 
particularly at the forehead in the beginning, and 
at the occiput during the course of the sickness, 
passing heats, giddiness, swelling in the pit of the 
stomach and belly ; moreover, feelings of repletion 
in the stomach, a symptom which commonly oc- 
curs, dull pains in the hips and legs, borborygmi, 
flatulency, the urine turbid and clayey, the sclero- 
tica of a dirty yellow, the iris weak, and the eye- 
ball a little enlarged. 



SEMEIOLOGY OF THE EYE. 



59 



In the first two or three days, especially when 
this fever announces itself by inflammatory symp- 
toms, the dirty yellow and greasy appearance of 
the sclerotica does not show itself, the eye is rather 
dull and aqueous, and the meibomian glandulse are 
frequently reddish and inflamed. It is only towards 
the eighth or twelfth day, according to the course 
of the fever, that this dirty yellow or greasy colour 
appears. 

If there comes an unexpected salutary crisis, 
and the gastric disorder decide itself either by 
stools resembling pap, by wholesome sweats, or by 
diarrhoea which is not too weakening, this dirty 
yellow of the eye, which grows daily lighter, dis- 
appears, and the other bad symptoms at the same 
time with the yellow of the eye, and constitute the 
epoch of convalescence. 

But if the crisis is imperfect, if the sweats become 
clammy, fetid, and weakening; if frequent diarrhoea 
takes place, if the urine takes a disagreeable co- 
lour, similar to chocolate or brown beer, with a bad 
smell, if the eyelids or the lips and the nose be- 
come blueish, if the greasy yellow of the eye aug- 
ments, if the look of the patient becomes stupid, 
the nails blue, if the tongue remains yellow or 
brownish or is covered with a thick, clammy, and 
blackish mucus, if sadness takes possession of the 
soul, if we perceive convulsive motions, and the 
pulse becomes small, frequent, and variable, all 
these symptoms are dangerous and indicate a fatal 
termination. Should one eye appear smaller than 



60 



SEMEIOLOGY OF THE EYE. 



the other, and the patient look at an object more 
attentively with one eye than the other, this 
sign, according to the observation of Stoll and 
our own, announces, in a positive manner, ap- 
proaching death. 

In all gastric fevers we may consider as a fatal 
sign the sudden change of the urine, that is to say, 
if it is sometimes troubled, sometimes of lemon 
colour, then clear and pure like gold, afterwards of 
a dark brown, finally of a dark red, and if we see 
swim on it greasy spots. 

The eye plays a very important semeiologic part 
in bilious fever. But here again, we are obliged 
to make a short explanation of other signs, in or- 
der to seize better the symptoms of the eye, and 
not to confound the burning hot or gastric fever 
with the bilious fever. In this fever the vegetative 
system of the organization is affected, during and 
even before its appearance, and the fever always 
presents itself under the type of a continued re- 
mittent. 

In the same proportion as the mind of the pa- 
tient is sorrowful and depressed, we may observe it 
in his eyes. The face during the very short period 
of the inflammatory state, presents a dirty com- 
plexion and dark red, the redness of the eye is not 
so sprightly as in the synocha. The face is some- 
times cachectic and pale, the eyes are yellowish, 
but rather of a saffron colour, and not of a greasy 
yellow as in the saburral fevers. 

In inflammatory fevers, the eye has some- 



SEMEIOLOGY OF THE EYE, 



61 



thing brilliant, but after some days, in bilious 
fevers, becomes weak and heavy ; it assumes an 
air of infatuation and vexation. The patients 
complain at the same time of a feeling similar to 
that which they would experience if they had all 
their limbs broken ; this feeling exists especially 
in the back, loins, and the hams. The head is 
warm, dull, heavy, and sometimes painful ; the 
pulse, in the short inflammatory period, is full and 
undulating, but never hard nor strong. This in- 
flammatory period being past, the pulse becomes 
undulent, soft, and frequent ; some days or some 
hours before the critical symptoms, it becomes 
sometimes again undulating and full, and at that 
epoch becomes at the same time more quick and 
more frequent. 

The face and the head are covered with a pro- 
fuse clammy sweat, of a bad smell. These patients 
are often subject to a more abundant secretion of 
spittle, the taste of which is bitter, or of a disgust- 
ing sweetness. This spittle has a whitish, frothy, 
soapy appearance ; the tongue is yellow, and of a 
colour similar to that of the bile. The patients 
feel in the stomach a disagreeable sensation of op- 
pression, as if they had worms. 

This state is accompanied with qualms and bit- 
ter, burning, and biting vomitings ; qualms some- 
times occasion vomitings in which different sub- 
stances are evacuated; there is inquietude and 
oppression in the hollow of the stomach, but what 
characterizes principally the bilious fever, is the 



62 SEMEIOLOGY OF THE EYE. 



desire of refreshing and acid drinks, and fresh air. 
During the inflammatory period, the stools are 
more brown than yellow ; they, however, grow yel- 
low afterwards, and become more frequent and 
liquid, and are apt to produce an itching in the 
anus. The urine during the same epoch is of a 
yellowish red, but changes afterwards and takes a 
saffron colour ; it becomes greasy, frothy, and co- 
lours the linen yellow. 

In the course of the bilious fever the periphery 
of the skin is sometimes changed, and a reddish 
eruption appears upon it. 

When the bilious fever is complicated with other 
forms of disease, for example, the bilious putrid 
fever, there is a more considerable and prompt 
tendency towards the chemical decompositions 
and dissolution of the humours, and then, from the 
very beginning, the eye offers a weak, troubled, 
sinister, and sad aspect, the sclerotica is deeper, 
greasy, and of a dirty yellow ; the eyeball open, 
and the iris more dilated. 

The bilious fever becomes dangerous and mor- 
tal, if instead of a decided crisis it is accompanied 
by inflammation, suppuration, or obstruction of the 
liver, accompanied by chronic diarrhoea and jaun- 
dice ; in this last affection, the eye is of a deeper 
yellow, blackish, and one observes in the sclerotica 
veins that appear torn. 

If there appears, at the same time, a feeling of 
heat in the intestinal canal, with a steady pain in 
the region of the liver ; if the urine is discharged 



SEMEIOLOGY OF THE EYE. 



63 



m small quantity, if it is brown or of a deep red, 
greasy and constant in its colour, having a blueish 
circle with a greasy pellicle on its surface ; if the 
thirst augments ; if red chaps appear on the 
tongue, and the mouth becomes blackish and dry ; 
if, moreover, the patients feel a strong nervous 
sensibility, with a profound sadness, and if there 
are, at the same time, grinding of the teeth, tris- 
mus, subsultus tendinum and masticatory motions 
in the inferior lips, accompanied by ferocious and 
stupid looks, we may renounce all hope of conva- 
lescence. 

We regard as favourable symptoms the critical 
motions which indicate an abatement of the mor- 
bid phenomena, especially the successive decrease 
of the yellow colour of the eye, which then begins 
to become clear; we see these sorrowful and weak 
looks change into open looks, provided that there 
existed not any organic defect in these individuals 
before the fevers, that they enjoyed the strength of 
adolescence or of manhood, and that the vegetable 
sphere be not weakened. — See the ulterior details 
upon the prognosis in the works of Peter Frank, 
Conradi, Richter, Heker, Marcus, and Reil. 

In the bilious fever the bile predominates every- . 
where ; the eye, urine, skin, and the intestinal canal 
furnish us the most convincing proofs of it. In the 
pituitous fever, on the contrary, phlegm reigns in 
all the organization. This fever forms itself more 
slowly than the bilious fever. 

The patient complains of an insipid taste in the 



64 



SEMEIOLOGY OF THE EYE. 



mouth and throat, which are covered with a kind 
of clayey mucus ; afterwards the teeth are covered 
with it to such an extent that the crown is scarcely 
visible. The patients have no relish for their ordi- 
nary food ; the tongue is covered with a thick 
and whitish mucus ; they are tormented with flatu- 
osities ; the eye appears in the beginning a little 
weak, and shows itself a little shining and aqueous 
during the exacerbations. However, afterwards 
the secretion of the eyes changes into inucus, and 
we remark then several slimy strice upon the cornea 
and the conjunctiva. The eyeball offers a charac- 
teristic sign in this sickness. I myself have 
always found it dilated and round, the iris sur- 
rounding like a thin veil, and it was absolutely 
slackened. 

In the course of the fever it was even insensible 
to slight frictions, and it presented the appearance 
of the gutta serena \ the look becomes frequently 
silly, or, to express myself better, like that of an 
idiot. The pulse is slow and short : it becomes a 
little firm during the exacerbation ; the stomach 
produces frequently thick matter. The patient is 
sad and dejected ; he has no appetite, without hav- 
ing, however, a bad stomach , he has an inclination 
without being able to sleep, and falls finally into a 
kind of drowsiness. The stomach, and the whole 
intestinal canal are covered with a clayey mucus; 
the body is curved, and the abdomen painful. 

The urine is, at the beginning, of a pale yellow ; 
afterward it becomes a little deranged, and re- 



SEMEIOLOGY OF THE EYE. 



65 



sembles the essence of tokay — one discovers in it 
a whitish and clammy deposit; swelling in the mouth 
and miliary eruption join it : the patients lose their 
will — they speak heavily, stammer, and cannot be 
understood. In several persons I have observed 
a very dangerous cough, without expectoration, 
accompanied by a symptomatic and asthmatic pain 
in the chest ; at last sensibility is suppressed in the 
vegetation of the organization by the very abun- 
dant secretion of slimy matter. 

The characteristic symptom of this fever is, 
that it is often of long continuance, and that it ter- 
minates frequently in not less than six weeks ; that 
it rages during moist weather, and particularly in 
damp and rainy autumns. The febrile symptoms 
diminish towards morning, but augment consider- 
ably towards evening, and the frequent sweats that 
occur procure no relief to the patient. Headache 
appears only in the first eight or ten days ; after- 
wards the head is rather oppressed than painful 
If the disease changes into putrid fever, we remark 
also in it, at the same time, all its characteristic 
symptoms. Stoll, Selle, G. A. Richter, Conradi, 
Raimann, give on this subject ample details. 

If this pituitous fever terminates happily, every 
thing must show itself extremely changed, the 
weakness of the eye disappears, the eyeball is 
closer, the iris assumes its natural tension, the 
looks are more lively, andshow some interest for 
present objects ; the eyeballs cease to be covered 
with mucus, and the latter disappears totally from 

9 



66 



SEMEIOLOGY OF THE EYE. 



the eye ; finally, the nervous and putrid complica* 
tions cease at the same time these symptoms 
appear. Should these changes not take place, and 
should the fever attack persons subject to diseases 
of the mucous membranes, or persons debilitated 
or in a convalescent state, it terminates only in 
death, and all the means of art are fruitless. 

However, the rational physician ought not to 
neglect to observe the other phenomena of the 
organization, and compare them with the expres- 
sion of the eye ; for as the eye grows gradually 
clearer, the pulse, the tongue, the cutaneous trans- 
piration, the urine, and the digestive functions, 
must change at the same time, and announce a 
prompt cure. 

In the same proportion the intellectual faculties 
must confirm the signs of convalescence, the patient 
must cease to speak nonsense, the temporary 
drowsiness vanishes, the calm of the mind mani- 
fests itself by a new interest for life ; when these 
phenomena are present, the cure is not remote. 

The worm fever (febris verminosa) a variety of 
the pituitous fever, is in the first instance produced 
by the presence of worms. It is commonly com- 
plicated, for it changes suddenly into a pituitous 
fever, which we may say is but a secondary affec- 
tion, being primitively produced by worms, which 
continue during the sickness. 

This worm fever may proceed from the ascarides, 
lumbricoides, himbrici, from the trichocephalas, or 
finally, from ascarides and solitary ivorms. But we 
can properly admit the existence of the worm fever 



SEMEIOLOGY OF THE EYE. £7 

only when the patients discharge these worms a 
little while before the sickness, or at the begin- 
ning ; for the physicians often confound the primi- 
tive pituitous fever with the worm fever, and the 
existence of worms when there are none, and 
when we must not even suppose any ; for admit- 
ting falsely the presence of worms, the treatment 
may put the life of the patient in danger. Be- 
sides the constant symptoms of the pituitous fever, 
the worm fever is distinguished by the following 
marks, which, after our numerous observations, 
are especially isochronously visible in the eyes, 
and which very seldom will mislead you. Children 
are particularly subject to the worm fever : their 
eyes are at first brilliant, the sclerotica is of a 
blueish white, the eyeball is a little dilated, and 
grows larger and becomes more round during the 
course of the sickness ; afterwards the sight dou- 
bles, blue circles form round the eyes, a swelling of 
the nose and the upper lips, and besides strong pains 
are felt in the belly; they are accompanied by 
spasms and convulsions, in the same manner as is 
seen in the nervous pituitous fever. 

The fever is often very high, the patients have 
an insupportable itching in the nose, the com- 
plexion changes several times during the day ; the 
belly is a little swelled, and qualms take place in 
the morning ; the secretion of the spittle is also 
augmented. The urine is pale, troubled like whey, 
and during the course of the sickness it becomes 
often brown like beer, which is a mortal sign. 
Colics, dizziness, a variable pulse, grinding of the 



68 



SEMEIOLOGY OF THE EYE. 



teeth, palpitations of the heart, convulsions, use- 
less efforts to go to stool, are characteristic symp- 
toms of the worm fever. 

The treatment of this disease consists in de- 
stroying or evacuating the worms by suitable reme- 
dies. When we have succeeded, the eye and the 
urine very soon change ; the eyeball becomes more 
moveable, and is not so much dilated, but more 
straitened. The sclerotica regains its white colour y 
and loses its uncommon brightness; the urine 
becomes clear, and ceases to look like whey. 
Gradually as these symptoms appear, all the other 
symptoms change also for the better. 

It is only by these changes, that the health is by 
degrees re-established. But, on the contrary, the 
eyeball remains big, and becomes more insensible ; 
the urine loses its red and brownish colour, and 
takes a sweetish and qualmy odour; the belly 
swells considerably, and all the signs indicate that 
the patient is worse; then the worm fever changes 
into hectic fever, or into a slow nervous fever, and 
death terminates the life of the child by an attack 
of convulsions. 

We are now going to trace the expression of 
the eye in the putrid fever ; but permit us to pre- 
sent, in the first place, an important observation 
of the diagnosis and prognosis. 

Before the disease is fully formed, and before it 
has reached the zenith of its malignancy, the head 
and the digestive functions are affected ; the ap- 



SEMEIOLOGY OF THE EYE. 



69 



petite is wanting, sleep is uneasy, the patients com- 
plain of fatigue, heaviness in the limbs, they are in 
bad humour and melancholy, the eyes are weak, 
the eyeball a little dilated, the sclerotica a little 
dirty, not looking yellow at the beginning; the 
skin is humid and glutinous ; the patients perspire 
during the night without feeling better in the 
morning. They perceive in their mouth a bitter 
and then an insipid taste. 

The urine is oily, thick, of a dark red, turning 
almost to brown, the stools are of an insupportable 
odour. 

Putrid fever never begins with a violent shiver- 
ing, it is rather moderate, and the heat that accom- 
panies it is not extreme, and remains about the 
same temperature, and communicates a burning 
sensation to the touch ; the symptoms steadily aug- 
ment, and very soon reach the highest degree. — 
This fever offers then rather the nature of a long 
continued fever, though its primitive character be 
remittent ; the burning heat becomes still stronger, 
and the strength of the patient diminishes quickly : 
discouragement, great indifference, and a real stu- 
pidity seize him. 

There exists, at this epoch, a particular disgust 
for all kinds of nourishment ; the headaches are 
insignificant, the head is rather benumbed. During 
the night we observe a slight delirium ; the eyes 
are tumefied, the look of the patient is melancholy, 
the eyes are troubled, and often so weak, that at 
the very first look we may recognise in them the 



70 



SEMEIOLOGY OF THE EYE. 



putrid fever : moreover, the iris is very much re- 
laxed, and the eyeball rather large than small ; the 
sclerotica presents an aqueous and dirty white 
aspect. 

Whilst the sickness is progressing, we observe 
a morbific secretion of the glandular meibomian so 
augmented, that the eyelids adhere together during 
the night. The mucus has often a cadaverous 
odour and a qualmy taste ; at the same time the 
patient casts lazy and stupid looks around him, the 
hearing is difficult, the tongue dry, chapped, black, 
often covered with mucus and swelled ; afterwards 
the lips, teeth, and the interior part of the mouth 
become covered with a greasy matter, which at a 
certain distance resembles soap ; this secretion 
abounds especially about the nostrils. The pulse 
is weak, sometimes extremely quick, variable, and 
at other times very slow, whilst all the other symp- 
toms gradually become more alarming : the voice 
is weak and trembling ; the secretions and excre- 
tions of the organization have a fetid odour, and 
a smell of putrefaction; then diarrhoea and he- 
morrhage of a cadaverous odour take place. 

The skin offers a remarkable change — it has a 
bad aspect, is frequently dry, and one sees on it 
exanthems of all kinds ; the petechias appear some- 
times marbled, covered with a white miliary erup- 
tion similar to small pearls, which become by 
degrees yellow and then blackish, according as the 
decomposition of the humours progresses in the 
vegetative sphere of the organization. 



SEMEIOLOGY OF THE EYE. 



Aphthae, of different colours, form in the mouth, 
very similar to poisonous mushrooms, and which 
extend themselves to the throat : at last the sensi- 
bility is so powerfully excited in the reproductive 
sphere of the organization, that a secondary typhus 
appears. It is then that the putrid fever has 
reached its highest degree, and to the phenomena 
which we have just mentioned, are superadded 
nervous symptoms, such as trembling of the limbs, 
convulsions, subsultus tendinum, a violent and long 
delirium, meteorismus, swoons, evacuations, the 
greatest powers of the system joined to the greatest 
degeneration of the humours ; finally, general pa- 
ralysis and death terminate this frightful fever. 

No kind of synochus terminates promptly by 
critical evolutions. It is the same with the putrid 
fever ; it terminates frequently in inflammation and 
suppuration of the liver, often in visceral obstruc- 
tions, sometimes in chronic diarrhoea, jaundice, or 
dropsy. 

Even then, when the important period of the 
crisis approaches insensibly, the eye indicates with 
exactness and fidelity the favourable or unfavour- 
able changes of this fever, in which it always be- 
comes us to pay particular attention to the urine, 
eye, and sweat. When the eye becomes brighter, 
when it has lost its melancholy aspect, when the 
looks become less sad, when the troubled and 
blackish colour of the sclerotica, the eyeball, and 
nostrils disappears, when the urine has a sediment, 
when it does not contain blood in dissolution, when 



72 SEMEIOLOGY OF THE EYE. 



it only becomes deranged late, when it runs easily 
and in abundance, and has a yellow, brown, or red- 
dish deposit, and when a free perspiration, with 
augmentation of strength takes place, when paro- 
tis and furuncles form, when a difficulty of hearing 
or deafness occurs, when an eruption appears 
round the mouth and nose, these happy symptoms 
are generally followed by a prompt recovery. 

But if the eye continues to become more and 
more melancholy and weak, and the eyeball dilated 
considerably, if the sweats become excessive, if 
the prostration of the powers of the system is con- 
stantly augmenting, if the cadaverous odour of the 
patient becomes stronger, the pulse diminished 
and varied, if the urine resemble brown beer, or 
if it is mixed with blood or with thick matter, if 
the delirium becomes more frequent, if severe dart- 
ing pains occur, these symptoms indicate the ap- 
proaching formation of gangrene, in which the 
chemical decomposition overcomes the dynamic 
life in the organization, and announces that the 
patient will soon fall a victim to the disease. 

The putrid fever which takes place in winter or 
spring, is of a milder character than that which 
occurs during the heats of summer, particularly 
during a stormy season, accompanied with warm 
rains, especially if this disease attacks feeble per- 
sons of a soft and spongy constitution ; such cases 
are generally hopeless, and commonly terminate 
fatally on the seventh, fourteenth, or twenty-first 
day. 



SEMEIQLOGY OF THE EYE. 



73 



Finally, the putrid fever is positively mortal, if 
there occurs a paralysis of the sphincter of the 
anus, of the bladder, of the muscles, of the pha- 
rynx, of the extremities, or the lungs, the brain, or 
congestion of the organs of the senses ; a gangrene 
of the interior parts, which makes rapid progress 
and spreads an insupportable fetid odour, is mor- 
tal in a few days. From the beginning of these 
phenomena, the eye is always changed in an un- 
common manner; the patient has a stupid look, 
sometimes a squint: occasionally the eyeball is 
dilated, and announces infallibly a speedy dissolu- 
tion. In the intermittent fevers which form a par- 
ticular order, and which are distinguished from the 
continent as well as from the continued and remit- 
tent fevers, there are intervals of perfect freedom 
from febrile action, which we call apyrexia. 

These fevers have their origin particularly in the 
vegetative element of the organization, and accord- 
ing to the individuals, the exterior coincident influ- 
ences, and the reigning constitutions, they approach 
the synochus, synocha, or the typhus fever. 

They attack particularly the sympathetic system, 
and may consequently bear the inflammatory putrid, 
or nervous character, so that these complications 
may produce intermittent, gastric, bilious, atrabi- 
lious, and pituitous fevers. Fearing, however, to 
wander too much from our principal object in 
tracing the characters of this fever, we refer our 
readers to the following classical authors, viz. : 
Senac, Heinrich, Collin, Sauvages, Torti, M. Stoll, 

10 



74 SEMEIOLOGY OP THE EYE, 

Vanhoven, J. P. Franck, S. G. Vogel, A. G. Richtery 
Quarin, Sebastian, Raimann. 

We shall confine our observations particularly 
to the changes which the eye presents in the dif- 
ferent stages of this fever. 

During the cold fit, the eye is rather clear than 
troubled ; the sclerotica has a bright colour, and 
the eyeball is rather more contracted than dilated : 
fear and anxiety manifest themselves in the looks 
the face is pale, the skin contracted, the extremi- 
ties, the nose, and the ends of the fingers are cold} 
the hands and nails turn blue ; a cold fit commonly 
occurs, during which the limbs tremble and the 
teeth chatter; the stomach is swelled. These 
symptoms are followed by nausea, vomitings, 
qualms, and flatuosities ; the mouth becomes dry 
and clammy, the urine is limpid, the thirst violent* 
the pulse concentrated, quick or slow, short, firm, 
unequal, or altogether suppressed ; the shiverings 
are sometimes so violent, that they degenerate into 
convulsions, which I have seen three times in my 
practice. 

In the second period of the intermittent fever or 
the hot stage, where the patients suffer the most, 
we frequently witness vomitings, pains in the back, 
with headaches and unquenchable thirst. All the 
periphery of the skin is dry, the pulse becomes 
quicker but more regular, respiration humid and 
difficult ; the eye is then brilliant, the sclerotica is 
red, the eyeball somewhat contracted, and we re- 
mark in it oscillations; the looks are more sprightly; 



SEMEIOLOGY OP THE EYE. 



76 



the urine is frequently redder, often dark in colour, 
at other times clayey, especially if the gastric state 
predominates. At the same time the eye is trou- 
bled, a little weak and dirty, and presents but little 
vivacity. 

In the third or sweating stage, the extreme thirst 
and dryness of the skin disappear. At this epoch 
the eye is more weak, the eyeball appears larger, 
the iris does not seem so bent and is rather loose, 
the sclerotica appears aqueous, the reddish white 
has disappeared; sometimes the eye is in tears, 
which happens especially when the attacks of the 
second period have been too violent and too 
long. 

The tongue is moist, generally a profuse perspi- 
ration ensues ; the pulse becomes soft, frequently 
slow ; the patient often begins to perspire, and the 
sweat is clayey and has an acid odour ; the urine 
deposits a reddish and slimy sediment ; black or 
pitchy stools sometimes occur, and occasionally 
diarrhoea. 

We witness sometimes an eruption of small 
pimples round the lips, especially during a quartan 
fever. These symptoms are followed by great 
weakness, by a rending of the limbs, and even, but 
rarely, by a transitory comatose state. 

The febrile paroxysm having passed through its 
three stages, is succeeded by a state of apyrexia ; 
in this interval, where health is only apparent, the 
eye has always served as a guide in the diagnosis 



76 



SEMEIOLOGY OF THE EYE. 



of intermittent fevers, and the phenomena which it 
presents, have rarely deceived us. 

The eye offers at this epoch absolutely the same 
aspect as in the first inflammatory period of gonor- 
rhoea ; it is of an aqueous brilliancy, the sclerotica 
is more blueish, and in certain circumstances dirty 
and troubled, especially when the digestive organs 
are suddenly attacked. Sometimes we remark in 
apyrexia that the tongue is covered with a white 
or yellowish mucus, the patient experiences a 
sweetish or bitter taste, and has a decided aversion 
for meat, and all other dishes in which meat is 
contained. 

The patients are very sensitive and irritable ; 
their complexion is cachectic and bad ; the urine is 
disturbed, clayey, of a dark red or saffron colour 
when complicated with biliary derangement. 

The complications of this fever manifest them- 
selves in a very positive manner in the eye at the 
same time with the other phenomena. The gas- 
tric intermittent is visible in the eye by the yellowish 
appearance of the sclerotica. This symptom is 
always accompanied by a bitter taste, with a yellow 
tongue covered with a clayey matter, and trembling 
of the underlip ; a feeling of plenitude in the sto- 
mach, efforts to vomit, frequent sputations, heavi- 
ness of the head, giddiness, a pain peculiar to the 
interior part of the head, anxieties, fetid diarrhoea, 
dark red or yellowish urine, desire for acid drinks, 
and ardent thirst. 



SEMEIOLOGY OP THE EYE. J*] 

The nervous intermittent fever presents itself in 
the eye, by a weak, uneasy, and frequently a stupid 
look ; the face is, at the same time deformed, and 
the patient is light-headed. 

The fever itself inclines towards the continent, 
and during the whole continuance of the apyrexia, 
heaviness, weakness, headache, giddiness, inclina- 
tion to sleep, continue to take place; there also 
appear prostrations of the strength, vomitings, 
faintness, and diarrhoea. The urine is aqueous, 
sometimes red, fetid, thick, and passes with diffi- 
culty. 

We remark at this stage, palpitations of the 
heart, separate convulsive motions, the pulse is 
irregular, the tongue and the lips are exceedingly 
dry; great mental prostration and despondency; 
there appear, also, white swellings in the mouth, 
and in these moments the eye appears very weak, 
the eyeball more dilated, the iris relaxed, and its 
tension lost; the sclerotica has a dirty aspect. — 
Several of these phenomena take place even dur- 
ing the apyrexia. 

The varieties of this fever, such as the nervous 
soporific fever, the syncopal fever, the algid fever, 
are equally to be observed in the eye. 

In the syncopal fever, which is accompanied by 
extreme debility and vital weakness, the eye is dull, 
and resembles that expression which announces in- 
ward and chronic pains, or profound grief. 

The soporific fever paints in the eye of the pa* 



76 



SEMEIOLOGY OP THE EYE. 



tient, stupidity, confusion, and the diminution of 
vitality in the sensible sphere. 

In the algid fever, we remark in the looks a 
certain perplexity, mixed with unquietness and anx- 
iety; sometimes the eye is attacked by convulsive 
motions, without, however, being red or inflamed ; 
the sclerotica is never red, but always of a weak 
splendour. 

In the concealed intermittent fever, we always 
observed the eye weak, and the patient looking 
sedate and sad. The sclerotica is then most fre- 
quently dirty, yellowish, and resembles that state 
which the eyes represent in gastric fevers; the 
eyeball is rather dilated than contracted. 

The bilious intermittent fever, commonly accom- 
panied by incidental symptoms arising from the 
liver and bile, offers a sad eye, which gives to the 
countenance a mournful expression, and the scle- 
rotica seems to be dyed with a gamboge tinge. If 
this fever becomes splenetic intermittent, the eye 
is extremely weak, looking straight forwards, and 
has a greasy and very dirty aspect ; the eyeball is 
very large, the sclerotica of a dark yellow : the 
complexion of the face is earthy, and all the phe- 
nomena denote at the same time, that the vital 
principal is vigorously attacked, as we see it in the 
pituitous fever, with this difference, that the symp- 
toms are most distinct during the attack. The 
eye is generally weak, the eyeball larger, and the 
iris bent down, and a thick mucus is gathering in 
the corner of the eye. 



SEMEIOLOGY OF THE EYE. 



79 



Expression of the eye in typhus. 

If we consider that the optic nerve, the tunics of 
the eye, and several other nervous ramifications, 
not less important, cross and surround the eye in 
its different parts ; and if we reflect upon the com- 
munication that exists between the brain and the 
eye by means of these nerves, we can easily under- 
stand why the eye is intimately affected with such 
phenomena, and suffers such considerable plastic 
changes in the diseases of the nervous system, 
which attack particularly the head and brain.— 
And this fact is confirmed by experience : I have 
especially observed myself this truth in the nervous 
fever, therefore we will describe, with the greatest 
care, the expression of the eye in this disease. 

The true idea of the nervous fever has been 
given to us by P. Franck, Hildebrand, and by Rai- 
mann in his pathological and medical therapeutic 
manual. We admit it also as a basis, and it is 
after these views that we present our semeilogical 
view of the eye in the nervous fever. 

Selle called this fever, with its species, febris 
atocta ; other authors call it — malignant nervous 
pestilential prison fever, feme nerveuse maligne, pes- 
tilentielle, jievre des prisons. 

It is a certain fact, that in this fever sensibility is 
primitively more or less attacked. Inflammatory 
symptoms always attend this fever in each stage, 
and it preserves or loses the inflammatory type for z 



$0 SSMEIOLOGY OF THE EYE. 

greater or less time according to the constitution 
of the patient and the state of the atmosphere ; 
for the inflammatory period may last several days* 
or only half a day, and even only some hours in 
complicated or very malignant fevers ; therefore 
the treatment of this fever requires close attention, 
much judgment and sagacity, with a sound know- 
ledge of ancient authors, and considerable practi- 
cal experience. 

The nervous system and sensorium are always 
more or less disturbed in typhus. The latter 
reigns sporadically, epidemically, with or without 
contagion, and assumes the gastric inflammatory 
or putrid character. 

When this fever does not reign epidemically, 
but is rather sporadic, we have often remarked, 
that seven or eight days before the irruption of the 
fever, the patients had a certain premonition which 
manifested itself in the intellectual and physical 
functions, but especially in the eyes. These indi- 
viduals had a sad and sometimes a slightly fero- 
cious look, and the eye presented an air of discon- 
tent. The same fact has also been remarked by 
J. Skinner, in the plague which committed its ra- 
vages at Malta, during which the furious looks of 
persons who did not believe at all they would be 
attacked, were the precursors of the disease. — See 
Philos. Mag. April 1815. 

The nervous fever is distinguished by the follow- 
ing characters : it begins with chills and heats ; 
these two symptoms are never violent at the be- 



SEMEIOLOGY OF THE EYE. 



81 



ginning of the fever, the chill especially is neither 
* very severe nor long, the burning in the head troubles 
the patient less than in the synochus and synocha. 
The fever is at first rather slight than violent, and 
j the eye announces a sadness, interior pains, the 
i tunic is brilliant, and the sclerotica slightly red- 
dish; the eyeball a little more contracted than 
dilated. 

This fever is irregular without a settled type ; it 
is neither continued nor decidedly remittent. Seve- 
ral physicians have classed it among intermit- 
tent fevers. According to our observations, it is a 
continued fever with irregular exacerbations, and 
changing suddenly. These symptoms moderate 
apparently, and often encourage hopes which are 
frequently deceitful, and the appearances of the 
eye are not less so, if we do not pay particular at- 
tention to it. 

It is, therefore, indispensable to examine repeat- 
edly, during the day, the eyes of patients attacked 
with nervous fever, especially during the exacerba- 
tion, and also when this state has moderated ; by 
proper attention to this rule, and taking into con- 
sideration, at the same time, the other morbid phe- 
nomena, it will not be difficult to determine, in a 
pretty positive manner, the greater or less danger 
of the disease, for the nature of this disease can 
never be decided accurately, by deductions drawn 
from the malignancy of the symptoms during the 
exacerbations alone ; it absolutely requires a true 
and synthetic examination. 

11 



82 SEMEIOLOGY OF THE EYE. 

In the course of this work we shall give the re- 
sult of our numerous observations upon this inte- 
resting subject. Besides its individual character, 
this fever is distinguished by an extraordinary weak- 
ness from its very beginning, and we remark the 
oscillations and other nervous symptoms which 
characterise it. This prostration of strength, 
spontaneous lassitude and languor, which subdue 
the most robust as well as the feeble, are what 
principally characterise typhus. 

This weakness is to be observed in the eye, 
during the exacerbation, by the following signs : 
the eye appears indeed sparkling, the sclerotica 
becomes also sometimes a little reddish, but this 
never happens in so high a degree as in the syno- 
cha ; the iris is rather contracted than dilated ; if 
there exists a violent trembling in the latter, and 
if, at the same time, the sclerotica appears dirty, it 
is a sign of malignancy ; if during the momentary 
remission of the fever, the eye is very weak and 
dull, if the eyeball is dilated, the iris relaxed, 
the tunic troubled, and the sclerotica fat or of an 
aqueous white, this state of the eyes indicates the 
most violent affection of the sensibility in the orga- 
nization of the patient. Besides that, we remark 
in typhus a trembling, weak, and uneven pulse, 
which P. Franck describes as very variable, some- 
times full and equal, sometimes short, intermittent, 
and almost imperceptible under the finger. 

In the stupid fever Franck and Reil have ob- 
served a full and strong pulse. In this dull nervous 



SEMEIOLOGY OF THE EYE. 



83 



fever, we have found the eye, in the highest stage 
of the fever, absolutely weak, and the eyeball 
dilated ; it seems overwhelmed with sleepiness, as 
we see it in persons who have been suddenly 
awakened; the sclerotica is never pure, but is 
always troubled as if by tears. In the course of 
the fever the tunic is troubled and dull. This last 
symptom is more distinct in the moments of abate- 
ment ; it is accompanied with a dull and heavy 
look, and the sclerotica is dirty. 

The nervous state displays itself especially by 
spasms, palpitations of the heart, anxieties, trem- 
bling, fright, and by an exalted imagination. The 
motions of the soul alternate with the same 
rapidity as the pulse ; the mind is dejected, sad, 
and discouraged ; the patients laugh or weep some- 
times : they have frightful visions, subsultus ten- 
dinum, and convulsions of all kinds ; a stupidity 
manifests itself in the looks, local paralysis occurs, 
the senses become weakened, the eye ceases to 
distinguish objects any longer distinctly, the patients 
often complain of obscurity in the room, but which 
exists only in their eyes; they lose sometimes the 
power of speech, a symptom which disappears and 
appears again with equal promptitude. 

As the sensorium becomes affected, delirium 
is manifest, and its severity is in proportion 
to the violence with which the brain and nervous 
system are attacked. It is sometimes, therefore, 
so violent as to amount to absolute phrenzy. — 



84 



SEMEIOLOGY OF THE EYE. 



During the delirium the eyeball is always con- 
tracted, and the eye, during the inflammatory 
period resembles often the eye in the synochus. 
It is only in the remissions that it appears dull, and 
deprived of brilliancy and life ; it is by this that we 
may know the difference in the fever. 

We must, however, not neglect the examination 
of the pulse, and other morbid phenomena. If, 
on the contrary, the fever passes from the synocha 
to typhus or gangrene, the eye appears in the 
first case weak, the iris is relaxed, the tunic more 
brilliant, the sclerotica is bright. In the second 
case, the eye has a celestial look, and is surrounded 
with a particular light, the eyeball is larger than it 
was in the previous state, the sclerotica is of a 
humid, brilliant, whitish colour, the looks have 
something mysterious and energetic ; in a word, 
language is inadequate to characterize the extra- 
ordinary appearance of the eye. It is necessary 
to have observed it as it appears in patients, to es- 
timate properly the force of these observations. 

In the versatile nervous fever (nervosa versatilis), 
the eye in the first stage of the disease is a little 
inflamed and brilliant, the sclerotica appears a 
little reddish, and the vessels of the iris are en- 
gorged with blood. 

If the fever reaches its highest state, and if there 
exists at the same time a delirium, the eye during 
the exacerbation is altogether that of a furious 
man, and becomes ferocious and bright ; the eye- 



SEMEIOLOGY OF THE EYE. 



85 



ball is much contracted, the coats shining and the 
sclerotica is very frequently red, resembling at this 
epoch the eye of a person with the synochus. 

In the nervous fever, properly so called, {typhus 
nervosus,) the eyes are brilliant, steady, sometimes 
even inflamed, and a little shut. The hearing is 
alternately hard, then very good or very sensible : 
the disorder of the head alternates with dizziness, 
and a tranquil or violent delirium; somnolence 
with want of sleep, inquietude, anxiety, and dejec- 
tion with gaiety. 

The urine in this fever is at first aqueous, abun- 
dant, and then becomes milky ; sometimes also of 
a lemon colour, with a mucous sediment. The other 
functions of the organization are not less variable 
than the pulse in nervous fever ; the belly is some- 
times too constipated, at other times too open, 
sometimes perspiration is too small, and at other 
times too free ; the skin is sometimes too rough 
and dry, at other times it is covered with copious 
sweats ; the exanthems appear often with the sick- 
ness itself, as happens in the measles. 

In the course and during the last period of the 
sickness, we see the kernels swell up, there appear 
also parotis, bubos, bloody flux, and some vague 
pains are felt in different parts of the body. We 
remark gangrenous spots or gangrene appears 
itself; respiration becomes painful, and convulsions 
and inexpressible pains, with the greatest weak- 
ness, take place. 

In this period of the nervous fever the eye is ex- 



86 SEMEIOLOGY OF THE EYE. 



tremely dull, the eyeball dilated, and the iris rather 
pale and relaxed. In this stage the patient sometimes 
appears to be getting better, and is suddenly cut 
off by death. The physician ought to be very 
careful not to be deceived by these apparently 
favourable symptoms, but pay particular attention, 
especially to these three essential points. 

1. To the expression of the eye. 

2. To the change of the moral character of the 
patient; and, 

3. To the change of the pulse during this 
period. 

The eye, in this last epoch of life, offers a par- 
ticular and remarkable aspect; the eyeball is 
always larger, the iris has a reddish brown colour, 
and the albuginea is white, but aqueous ; the eye 
is very sensitive to light, and absolutely cannot bear 
it ; the looks are uncertain and variable; the mind 
of the patient is extremely sad or very gay, there- 
fore he begins to weep or laugh in an extraordi- 
nary and striking manner. 

The pulse at this epoch is remarkably variable, 
sometimes slow, regular, and undulating ; some- 
times violent and short or hard and short; some- 
times intermittent and almost insensible. These 
changes happen more than twenty times during 
the day. 

In contagious typhus, which is very seldom 
preceded by precursory symptoms, the eye is at 



SEMEIOLOGY OF THE EYE. 



87 



first weak in the exacerbation, the eyeball is more 
contracted, and a little dilated in the remissions. 
As long as the inflammatory period continues, the 
albuginea is reddish, and the looks are a little fero- 
cious and bright ; but this does not last long. 

The other phenomena which we observe in the 
eyes, depend, in this kind of typhus, on the nature 
of the fever itself. Those who desire more know- 
ledge upon this subject, may consult the excellent 
treatises of Hufeland, Horn, J. Grunther, (Einige Be- 
merkungen ueber diejezt herrschende Fieberform, 
von D. Joh. T. Gunther,inSvo. 1814,s.40.) Professor 
Loebel (ueber das wesen und ueber die heilung des 
nervenfiebers in und um Jena, von Michaelis, 1813, 
bis Ostern 1814;) and the Annalen der heilkunst 
des yahrs 1814, April; artistische Mittheilungen. 

Without doubt it is useless to repeat here, that 
there exist different species of this kind of fever. 
During the winter, especially when the sky is clear, 
and there reigns a dry east or north wind, the ty- 
phus is always of an inflammatory nature. In an 
inconstant spring, and at the beginning of sum- 
mer, it is commonly gastric or bilious ; in summer 
even, and in the beginning of autumn, it is putrid, 
and towards the last part of the season it offers a 
pituitous complication. 

In the inflammatory typhus, we remark phe- 
nomena similar to those of the synocha, as for 
example ; a hard pulse, which is sometimes full 
and sometimes strong, considerable thirst, the 
face red and inflamed, violent headaches, the 



88 SEMEIOLOGY OF THE EYE. 



tongue and nose dry, pains in the muscles, the eyes 
red and inflamed with ferocious looks, the eyeball 
contracted, and the iris, with its vessels, red and 
choked up. The delirium in typhus is not tran- 
quil, but violent and lasting ; the urine is scanty, 
troubled, and inflamed ; the stools are dry and not 
frequent, and the skin is rather dry than humid. 

In the gastric nervous fever, the gastric state 
displays itself from the very beginning of the fever; 
the patients lose their appetite; the tongue is 
much covered with slime, the whole vegetative 
system is depressed, the complexion is yellowish, 
the stools are thin and fatiguing, and the fever 
offers the remitting character ; the eye is of a dirty 
yellow. In the course of the fever the tongue 
becomes more yellow ; the periphery of the skin 
assumes a bad colour, and the sclerotica a saffron 
colour : the eye itself is weak, sad, and sunken ; 
hiccough, violent headaches, a feeling of oppres- 
sion in the pit of the stomach, a thick, clouded and 
brownish urine, which becomes aqueous in the 
remissions, and violent deliriums, characterise this 
kind of typhus. To these symptoms soon succeed 
convulsions, subsultus tendinum, swoons and 
lethargy, and convulsions end the last period of 
life. 

In this last period the eye is extremely dull, with 
occasional ferocious looks, similar to those ob- 
served in the last stage of dropsy of the head; 
the albuginea is of a clouded yellow, and the eye- 
ball large. 



SEMEIOLOGY OF THE EYE. 



The pituitous typhus indicates its nature from the 
very beginning, by the prevalence of slimy matter 
in all the vegetative organs, joined to the charac- 
teristic symptoms of typhus. In this nervous fever, 
the mouth and the eyes are, from the beginning of 
the first period, covered with a clayey matter ; the 
tongue is covered with a whitish mucus, and the 
stools are slimy ; the urine has a slimy sediment* 
The pulse, from the beginning to the highest de- 
gree of the disease, is weak, slow, short, and in- 
termittent ; the fever is not continuous, but slow. 
The weakness of the patient is extraordinary, and 
the vital strength is extremely depressed. We 
have remarked in the patient dizziness, and dilata- 
tion in the eyeball. The eye appears weak, the 
tunic is troubled by slimy matter, and the albuginea 
appears of a white mucus. 

In the course of this fever we commonly observe 
to occur the white miliary, hiccough, swellings in 
the throat, and a pituitous peripneumony ; these 
symptoms are accompanied by an insupportably 
fetid smell. 

In the highest degree of the fever, sensibility is 
violently attacked, so that there result from it the 
risus sardonicus, with chattering of the teeth; want 
of sleep, accompanied by continual delirium ; the 
stupor of convulsions, until lethargy appears, and 
terminates these sufferings. In this last period of 
the disease the eyes are half open, dull, filled with 
tears, and the looks display stupidity and weakness 
of mind. 

12 



90 SEMEIOLOGY OF THE EYE, 

Of all the kinds of typhus, the most terrible and 
the most dangerous is the putrid typhus {typhus 
putridus,) for from the very beginning of this fever 
there exists an extreme nervous debility, accompa- 
nied by a tendency to the chemical decomposition 
in the vegetative and irritable sphere of the orga- 
nization. 

This fever is a remittent continent, and is distin- 
guished by a great prostration of the strength, with 
debility of the senses. The heat is continual, sharp, 
and corrosive (calor mordax^) 

In the beginning there are remissions, but the 
exacerbations of this typhus are violent, appetite 
is entirely wanting, all the excretions of the body 
have an insupportably fetid odour, and we com- 
monly observe petechia? and bloody flux accompa- 
nying this fever. The weakness augments every 
day, the pulse is weak, short, depressed, and often 
very slow ; the delirium which only presents itself 
during the exacerbations, becomes permanent in 
the course of this typhus ; the tongue, which is at 
first whitish and mucous, appears to be covered 
with a black crust. From the very beginning of 
the fever the eye appears dull, and loses afterwards 
all its splendour ; the cornea and the albuginea 
become dirty ; the iris is relaxed, and the eyeball 
constantly large. The eye becomes afterwards 
greasy, and the albuginea assumes a reddish colour, 
inclining towards green. The patient hears with 
difficulty ; the various symptoms follow each other 
rapidly, and the excretions are much augmented. 



9EMEI0L0GY OF THE EYE. 91 

In consequence of it the typhus distinguishes itself 
by weakening sweats, by '^hemorrhages and fetid 
stools ; the sensorium is entirely shaken, and we 
observe distinctly the decomposition of the hu- 
mours. In the last period of this putrid typhus, we 
always have found the eye very weak, the albuginea 
greasy, of a ceruse white or ash gray ; the eyeball 
was very large and insensible, and the looks ap- 
peared inanimate, sleepy, and stupid. 

As to the other symptoms, we request the reader 
to compare them with those of the putrid fever. 

Expression of the eye in the slow fever {typhus 
mitiorS) 

The slow or hectic fever may exist primitively 
or secondarily, and attack preferably one or the 
other system of the organization. It may also ap- 
pear as a fever concomitant with one or the other 
system or morbid organ, consequently there can 
be an inflammatory hectic fever, a lymphatic hectic 
fever, and nervous hectic fever. 

Not being able to engage in a particular patho- 
logical view of these fevers, we pass to the semei- 
logical expression of the eye, adding to it the 
characteristic and necessary symptoms of the fe- 
ver itself. 

What especially distinguishes this disease, is 
the insensible exhaustion of the vital forces, and 
its protracted duration. Its beginning often de- 



92 



SEMEIOLOGY OF THE EYE. 



ceives the physician; the pulse is weak, hard, un- 
even and quick, especially after dinner and supper. 
The fever has irregular exacerbations, which ap- 
pear several times during the day, or on the second 
or third day. 

At the moment of the exacerbation the eye is 
sprightly and brilliant, and the eyeball only a little 
more contracted than in health ; in the time of re* 
mission, on the contrary, the eye is weak, the iris 
relaxed, and the eyeball rather large than small; 
the albuginea is indeed white, but has a brilliant 
and aqueous aspect. 

To these symptoms we may add the following : 
the patients complain of a moderate chill, but still 
more of a temporary heat, disagreeable and burn- 
ing to the touch, without being insupportable : the 
heat in the insides of the hands and the soles of 
the feet, during the exacerbations, is a character- 
istic sign ; the urine is not discharged often, and is 
clear and limpid like water during the remissions ; 
but during the exacerbations, it is of a lemon yel- 
low, or red colour, with a red sediment : it has 
often precisely the smell of violets. 

In the course of the disease, we observe on the 
surface of the urine greasy spots, or a greasy skin 
of a milk blue colour, which attaches itself to the 
pot; the stools are rather soft than hard; however, 
we have found them hard, and similar to laurel 
berries, in the first weeks of the sickness. Thirst 
is always augmenting, especially at night ; the pa- 
tients complain, at the same time, of a disagreeable 



SEMEIOLOGY OP THE EYE. 93 



dryness of the palate and the throat. During the 
exacerbation, respiration is augmented, and the 
least motion of the body causes dyspnoea. It is 
very seldom that we do not observe, at the same 
time, an extreme lassitude and a dry cough ; the 
cheeks have sometimes a very bright circum- 
scribed red colour, sometimes they are pale and 
cachectic. Appetite is interrupted, but only during 
the course of the sickness. Sleep is uneasy, and 
does not refresh the patient ; the body wastes away, 
we may almost say, melts. The eyes sink deeper 
into the orbits, flesh disappears every where, and 
the bones are prominent. The skin fades away, 
relaxes, and becomes covered with wrinkles ; the 
hairs fall out, the nose becomes sharp pointed, and 
the patient looks like a true skeleton. 

During the exacerbation, we remark a tranquil 
delirium. Finally, the voice changes, it becomes 
difficult and hoarse ; the hands and feet swell. In 
this period the eye appears much troubled, the iris 
extremely pressed down, the eyeball more dilated 
than contracted, and the albuginea is of a snow 
white. 

We remark the sufferings of the patient by his 
looks, which excite pity and presage death. An 
easy end terminates the life of the patient, and 
we may well say, that it is extinguished like a 
candle. 

The inflammatory hectic fever presents inflam- 
matory symptoms, that accompany it from the be- 
ginning to the end. The eyes present in this hec- 



94 SEMEIOLOGY OF THE EYE. 



sic fever a vivacity and an extraordinary activity, 
though they are deeply concealed in the orbit ; the 
albuginea is always of a milky white. In the first 
stage, the eyeball is a little contracted, but it be- 
comes afterwards larger ; the eyes are also often 
in tears. The pulse is indeed small, but always a 
little hard. The urine is dark, or of a vivid red 
colour. It is the phthisic, called galloping con- 
sumption [phthisis cursiva^) which displays a strong 
and edged red on the cheeks, a sign which denotes 
the affection of the lungs. The fever is rather 
continent than remittent. 

The gastric hectic fever is recognised by a gene- 
ral prostration of the whole vegetation of the or- 
ganization ; besides that, appetite is wanting from 
the beginning. We remark also a mucus of a 
yellowish white, which covers the tongue of the 
patients, who are tormented with flatuosities 
and temporary vomitings. Diarrhoea appears af- 
terwards ; the colour of the face is cachectic and 
inclining towards yellow ; we observe even some 
symptoms of the jaundice, which disappear and 
appear again alternately. 

The patients feel a disagreeable pressure in the 
region of the liver, as if there were a stone upon 
it; the fever is remittent. The eye offers a sad 
and mournful aspect ; the albuginea is of a saffron 
yellow, or greasy aspect ; the eyeball rather dilated 
than contracted. 

During the progress of the disease, the eyes sink 
deep in the head. The patients display anxiety; 



SEMEIOLOGY OF THE EYE. 



95 



the pulse is uneven, frequent, weak, trembling, 
and intermittent ; weakness exists there in so high 
a degree, that the patients cannot give any idea 
of it 

The nervous hectic fever is distinguished by ner- 
vous symptoms, by a limpid urine with a mucous 
or whitish sediment; the pulse is as variable as 
all the other nervous and transitory phenomena 
which appear ; dizziness, palpitations of the heart, 
sadness, sighs and tears characterise this fever. 
The eye appears very dull and deeply concealed 
in its orbit ; the looks are inanimate, and cannot 
well sustain the influence of light, afterwards they 
have a stupid air. The patients are then very 
easily irritated, and besides very sensitive ; they 
are, during the exacerbations, in a delirium, and 
easily frightened. The faculties of the mind are 
affected; they diminish, and we remark in the 
progress of the disease, that the patient falls into 
fits of mourning, even after the time of the exa- 
cerbations. The pulse becomes variable, there is 
want of sleep, convulsions, and the whole train of 
symptoms indicating deranged sensibility appear ; 
at last paralysis puts an end to the patient's mise- 
rable existence. 

The pituitous hectic fever, which some physicians 
call lymphatic, is generally very slow in its progress, 
and has, at the beginning, an intermittent character. 
The patients have the face swollen, cachectic, and 
of an uncommon paleness ; the eye is disturbed, 
aqueous, and a slimy matter is seen to form in 



96 SEMEIOLOGY OF THE EYE. 



spots about the cornea ; the eyeball is much di- 
lated, and the iris pale and dull. Digestion suffers, 
and the patients are tormented with flatulency 
and vomitings ; they have an inclination to sleep, 
the head is confused, the respiration difficult, and 
increasing at times to an extent resembling fits of 
asthma. 

The feet and hands swell, the deglutition becomes 
painful ; we remark, also, white swellings in the 
mouth, the strength diminishes sensibly, the fever 
becomes continual, and hiccough, syncope, and 
diarrhcea carry the patient to the grave. As to 
the pulse, it is very variable, and becomes towards 
the end, quick, frequent, and intermittent. 

Expression of the eye in several local inflammations 
of the organization. 

Notwithstanding the very great changes which 
the eye presents, both in primitive and secondary 
fevers, it undergoes as numerous and varied 
changes in local inflammation of the several indi- 
vidual organs. 

We can only briefly expose here the symptoms 
which relate to semeiology, referring our readers 
for what concerns pathology to the classical works 
of Conradi, D'Zondi, Sprengel, Mayer, Richter, 
Wilson, and Vanderbosh. 



SEMEIOLOGY OF THE EYE. 



97 



Expression of the eye during an inflammation of the 

brain. 

A characteristic sign of this inflammation is a 
feeling of burning heat in the head, with a sensa- 
tion of cold at the extremities. This symptom 
appears always at the first period of the inflamma- 
tion, and disappears afterwards. Delirium also 
characterizes this inflammation; it begins by a 
grinding of the teeth, and proceeds even to 
phrenzy ; it does not exist at the beginning of the 
inflammation, but developes itself during the course 
of the disease. It is only in a violent inflammation 
of the brain, that the delirium commences imme- 
diately with the inflammation. 

In inflammation of the brain with a nervous cha- 
racter, where the sensible system is more affected 
than the irritable system, the fever is not less vio- 
lent ; the pulse is small, often extraordinarily fre- 
quent but very variable ; the pulsation of the tem- 
poral arteries is strong, and the temperature is 
augmented ; a steady pain demonstrates to us the 
seat of the inflammation of the brain ; but ordina- 
rily I have witnessed patients complain of pain at 
the occiput. When the pain manifests itself in 
the commencement of the inflammation, if it ex- 
tends to the neck, then the inflammation is in the 
cerebellum. 

It is true that this inflammation is more painful 
in its course, but it is not so dangerous as the in- 

13 



98 



SEMEIOLOGY OF THE EYE. 



flammatioii of the brain itself. The pain is ex- 
tended, during the progress of this disease, over 
the whole head ; sometimes it is accompanied by 
so severe a pulsation as to induce syncope. 

The eye, in the commencement of inflammation 
of the cerebellum, is red and brilliant; the pupil is 
more contracted, the veins of the iris are engorged 
with blood and of a clear red, and the albuginea is 
of a rose colour. The eye is very sensible ; when 
the brain itself is inflamed, the pupil is more di- 
lated than in inflammation of the cerebellum ; the 
eye, it is true, is inflamed, but not so brilliant ; the 
albuginea is white and brilliant ; the veins of the 
iris are not so engorged with blood. The eyes 
suffer, especially in the evening ; they are dry dur- 
ing the exacerbation. 

Experience has shown to me, that the inflamma- 
tion of the brain, which has an inclination to the 
synocha, offers a red eye, dry and brilliant : on the 
contrary, in that which attacks the sensibility in 
the vegetation, the eye is more suffused with tears. 
The pure inflammation of the sensible system is 
characterised by a sentiment of pressure in the eye, 
with ferocious looks, the pupil dilated, and unable 
to support the light. 

The looks become stupid, sometimes the eyes 
are very moveable, and the patient squints. The 
eyelids are ordinarily closed, and the patient can- 
not open the eyes, except with great pain. The 
senses suffer, and the face is red ; the cervical and 
temporal arteries beat strongly ; it is accompanied 



SEMEIOLOGY- OF THE EYE. 99 



with a mild or violent headache, which reaches 
the highest degree in the moments of exacerba- 
tion. It is necessary to observe the pulse, and 
particularly the eye in these moments, and you 
will be convinced of the danger of this inflam- 
mation. 

The respiration is difficult ; the mouth, the tongue, 
and the skin are dry ; the patient cannot sleep, and 
vomits frequently. In this period I have observed 
a great sensibility in the eye, and the pupil to be 
dilated. When the inflammation has reached its 
highest degree, the urine and stools pass involunta- 
rily, and sometimes they are retained ; the muscles 
of the face are contracted ; the extremities cold. 
Finally ensue risus sardonicus, trembling of the 
limbs, syncope, convulsions, and death. 

The principal characteristics of this inflamma- 
tion are also — a heaviness in the head, a debility of 
the senses, febrile excitement, a great irritability, 
the head very warm, a preternatural gaiety or sad- 
ness, vomiting, trembling of the limbs, steady and 
ferocious looks ; the eye is dry, the albuginea ex- 
traordinarily red ; in the course of the disease, the 
pupil is dilated, the face is red, and the tongue 
white and dry. Finally, delirium succeeds, and, at 
the same time, the pulse is variable, small, or trem- 
bling. In this inflammation the eye is a true mir- 
ror of the affection of the brain. 

The prognosis in this inflammation is unerring : 
when the cerebral substance is affected, the prog- 
nosis is nevertheless doubtful ; the younger and more 



100 SEMEIOLOGY OF THE EYE. 



delicate the patient is, the less favourable is the 
prognosis. Children commonly fall victims to this 
disease. If the eye loses its ferocious looks, if it 
becomes more calm, if the eyeball diminishes, if the 
trembling of the limbs and the vomiting cease, if 
the strangury, anxiety, gnashing of the teeth, diar- 
rhoea, subsultus tendinum,and paleness of the urine 
diminish, if anger and fury and gaiety or sadness 
disappear, we may hope for a recovery. 

We may foretell death : if we remark a conti- 
nual mastication, and a difficult and suffocating 
deglutition : if, at the same time, the eye appears 
large and squinting, if the albuginea is dirty or 
appears as it were covered with dust, if the eye- 
ball remains dilated, and the vomitings continue^ 
especially when it resembles coffee grounds, these 
are all so many signs of an approaching death. 

Expression of the eye in inflammation of the lungs*} 
{peripneumonia.) 

In this inflammation the organs of respiration 
are generally attacked, in the same manner as in 
inflammation of the cerebellum, the brain is affect- 
ed, and by that, the intellectual functions more or 
less troubled, in the same way as the functions of 
the respiration are troubled in inflammation of the 
lungs. 

The fever which accompanies the inflammation 
of the lungs, is continent : often the signs of a topi- 



SEMEIOLOGY OF THE EYE. 1Q1 



,cal affection precede by a long time the fever. If, 
on the contrary, the inflammation is violent, the 
fever appears almost at the same time. 

In those cases where the topical affection of the 
lungs precedes the fever, the eye is not so red and 
sparkling, but rather brilliant, and sometimes a 
little aqueous. The albuginea is white, and a little 
brilliant ; the looks are suffering, and rather arch. 
But if the fever appears at the same time with the 
inflammation, the eye is of a brilliant red, the face 
is alternately of a dark red, inflamed or pale ; the 
arteries of the neck beat briskly, and these symp- 
toms are often accompanied by a violent headache : 
a difficult respiration is joined to these phenomena, 
with a strong pain in the breast, which often be- 
comes very violent. 

But the gradations of the pain follow the course 
of the local affection of the inflammation : they 
are dull or heavy, then tearing, and the respiration 
augments the pain. The patient seems scarcely 
able to respire, and when he attempts to speak or 
move, it is with great difficulty and uneasiness ; the 
cough exists from the beginning of the disease and 
is dry, and the spittle is mixed with striae of blood ; 
the white fur upon the tongue, the dryness of the 
mouth, and the fine red of the lips, never fail to 
appear. 

The pulse is quick, frequent and unequal, heavy, 
and even often as full as in the synochus, and as 
softly undulating as in the synocha ; the heart 
beats strongly, the skin is dry, and the periphery of 



102 



SEMEIOLOGY OF THE EYE. 



the breast is sometimes, though very rarely, humid 
and wet. This happens especially in the first days 
of the affection. The urine is seldom passed, and 
is of an inflamed red, or it passes abundantly, and 
is tarnished or limpid, having the appearance of 
rhenish wine, with an odour of sulphur ; the stools 
are rare and hard, often brownish or similar to 
laurel berries. 

The genuine and well established peripneumony 
is always accompanied with fever, with a charac- 
teristic feeling of heaviness and oppression in the 
breast, accompanied by a cough which appears 
with a painful respiration, and which augments the 
pain in the breast. 

As long as the substance of the lungs and the 
pulmonary arteries alone are attacked with inflam- 
mation, and the disease has not yet reached the 
branches of the pleura, we remark neither the dull 
pain, nor the hoarse voice, or the other catarrhal 
symptoms. 

In the peripneumony only one lung is sometimes 
inflamed, and sometimes both. In the first case, 
the breast rises less high on the side of the inflam- 
mation. If both lungs are inflamed, we perceive 
no elevation of the breast, and respiration takes 
place by the agency of the diaphragma and abdo- 
minal muscles only. In this instance the eye has 
something characteristic. 

When the inflammation is confined to one lung 
only, the eye of the affected side is always redder, 
and casts more ferocious looks than the other. 



SEMEIOLOGY OF THE EYE. 



103 



It is very important to pay proper attention to these 
phenomena of the eye, especially in the first days 
of the inflammation of the lungs ; for from the very 
moment that the inflammation has made some pro- 
gress, and has reached a high degree, this distinc- 
tive character no longer exists, the two eyes being 
then equally red and inflamed. 

To these phenomena we may also add the fol- 
lowing : when there is but one lung inflamed, the 
pulse of the affected side is different from that of 
the opposite side — it is always quicker, more firm, 
more close, and more unequal. 

If both lungs are attacked at once, the pulse is 
about the same on both sides, which happily hap- 
pens but seldom at the beginning of the peripneu- 
mony ; but nevertheless I have observed this in a 
very delicate lady whom I attended with this affec- 
tion in Philadelphia. 

We must, at the same time, pay proper attention 
to the action of respiration. If, from the com- 
mencement of the disease, respiration is difficult 
and constrained, accompanied by great anxiety, 
we may almost always conclude that both lungs 
are inflamed, the respiration being never so vio- 
lently attacked in the first period of the inflamma- 
tion when only one lung is attacked. 

We have also, in many cases, to consider the 
position of the patients. Experience has taught 
us that they lie best on the side where the inflam- 
mation exists, whilst when both lungs are inflamed 
the patient prefers to lie on his back. 



104 SEME10LOGY OF THE EYE. 

According to the observations of Hippocrates, 
the tongue is also a characteristic sign of the pe- 
ripneumony. If it is white but on one side, it is a 
proof that the lung is inflamed on the same side ; 
if, on the contrary, the tongue is entirely white, both 
lungs are affected. It is thus that the ancient phy- 
sicians considered also the pain of the clavicle 
as a pathognomonic sign of the inflammation 
of the lung, and pretended that when there was 
but one lung affected, the clavicle was painful but 
on that side, whilst, when the pain existed in the 
two clavicles, the inflammation then existed in both 
lungs. 

The symptoms of inflammation of the lungs 
which we have just described, are of no value for 
the physician who observes them separately; they 
only become useful in examining and considering 
them collectively. 

It is then, only, that they lead to sound reason- 
ings, and then only are of advantage alike to se- 
meiology and therapeutics. We observe, besides, 
that the true peripneumony is influenced by the 
cold of winter and approach of spring. 

The peripneumony, like all internal local inflam- 
mations, may terminate by resolution, suppura- 
tion, or by adhesion, scirrhosity, or gangrene, and 
all these transitions are to be seen in the eye. — 
From the moment that a peripneumony resolves 
itself by expectoration, bleeding of the nose, sweat, 
or by a sediment in the urine, the eye loses its 
inflamed and sparkling, and at the same time, un- 



I 

SEMEIOLOGY OF THE EYE. ] Q5 

quiet appearance : the redness disappears, the 
eyeball which is a little contracted, resumes its 
normal forms. 

The engorged vessels of the iris are no longer 
visible; the looks of the patient become milder 
and more composed, and with this return of calm- 
ness in the eye, the other violent symptoms of 
the inflammation are observed to diminish also. 

If peripneumony is accompanied by suppura- 
tion, the inflammation of the lungs does not dis- 
appear entirely ; it terminates not however at the 
critical epochs of the seventh, eleventh, or four- 
teenth days, but a great deal later. 

The fever exists steadily either in a continued or 
remittent form, and abscess or vomica takes place. 
It passes frequently into suppuration in young, 
robust, and plethoric people, especially those who 
are fair and of a delicate and irritable constitution. 
It is true, that in these circumstances the eye lose^ 
its fire and uncommon redness ; the iris appears 
less contracted and bent; the eyeball resembles 
exactly an eye that has wept much ; it is aqueous, 
tarnished, and announces sufficiently by its looks, 
that there still exists an internal affection. 

We add further that the eyes lie very deep in 
the orbit, and that the patient is much tormented 
with a dry cough, the critical motions do not take 
place, the sweat is oily and clammy, the pulse fre- 
quent, soft, and sometimes irregular. The urine 
is at the same time troubled, and smells like oil or 

\4 



106 



SEMEIOLOGY OP THE EYE. 



violets — (these three signs are characteristic.) 
A circumscribed redness appears on the cheeks, 
and the nose becomes a little pointed. 

At the place where, during the inflammation of 
the lung a painful sensation was experienced, the 
patient then feels a heaviness or an oppression 
similar to a weight lying on it : he can only lie 
with comfort on one side, and if he were to attempt 
to rest on the other, he would experience consider- 
able distress and difficulty of breathing. 

The inflammation of the lungs sometimes changes 
into scirrhus or induration, which often happens 
with weak and scrofulous people, in whom a vicious 
system and the vegetative element predominate, 
if at the same time a cold and humid atmos- 
phere exercises its influence on these persons.— 
Peripneumony, which is not very violent, termi- 
nates often on the eleventh or fourteenth day with- 
out any critical evolutions ; the inflammatory stage 
ceases indeed, but the pulse is not therefore the 
less quick ; there exists, also, at that time, a dry 
cough, with stitches felt at intervals in different 
parts of the breast. 

The different positions which the patient takes 
in his bed, occasion him anxieties and some con- 
straint in the respiration, although there is at the 
same time an appearance of getting better. In 
these circumstances the eye appears dull and 
afflicted, and is very sensible to light, the albuginea 
is white and not inflamed, but it is of a disagree • 



I 

SEMEIOLOGY OP THE EYE. 10t 

able whiteness, the eyelids are sometimes swelled 
and attacked by an erysipelatous inflammation ; the 
glandulae meibomii are a little tumefied and greasy, 
which is a characteristic phenomenon. 

If at last peripneumony terminates in gangrene, 
which commonly happens with young, robust, and 
plethoric persons, when they are attacked with 
violent inflammation of the lungs, respiration be- 
comes extremely painful, and the circulation of the 
blood is constrained, the patients become very in- 
quisitive, the powers of the system diminish very 
considerably from the beginning of the disease ; 
the pulse is short and irregular, and sphacelus fol^ 
lows the gangrene immediately. 

The extremities and the face turn cold, and the 
pains of the breast cease suddenly ; the fever con- 
tinues, the breathing is quick and cold ; it ceases 
entirely, or there appears a blackish bloody expec- 
toration mixed with a tarnished lymph. During 
the gangrene the eyes have a heavenly appear- 
ance, but they cast nevertheless unquiet looks upon 
objects ; they remain fixed, especially upon their 
physician, with a particular pleasure. 

At the beginning of the gangrene, the eyeball 
appears smaller ; it becomes a little larger, but 
only after some hours when the gangrene has al« 
ready made some progress. The iris has a heavy 
appearance, but spreads at that epoch an extraor- 
dinary brightness, similar to a divine areola, 
which gives to the eye this celestial appearance by 



108 SEMEIOLOGY OF THE EYE. 

which the end of life commonly announces itself, 
— To establish a reasonable conjecture, it is not 
sufficient to pay particular attention to the pheno- 
mena which the eye presents, because in this dis- 
ease it is principally the affected part which can 
furnish us with the best information, and enable us 
to ascertain whether the affection exists in one or 
both lungs. We must also appreciate properly 
the pulse, the secretions and excretions. 

Not to pass the limits we have prescribed our- 
selves in this work, we shall briefly remark, that if, 
after a critical evacuation the eye loses its redness 
and savage fire, if it casts calm looks around it, 
and if, at the same time, all the other organic 
functions act with more regularity, (especially if 
there is but one lung affected, or if the inflamma- 
tion has attacked but the outside and not the sub- 
stance itself of the lung,) we may reasonably fore- 
tell a happy termination. 

In peripneumony it is very important to pay par- 
ticular attention to respiration, for it determines 
particularly the prognosis. However violent the 
symptoms may be during the course of the dis- 
ease, provided the respiration be not too painful, 
we may, in most cases, foretell a happy issue ; but 
if the respiration is very difficult, and accompanied 
with agony, all other symptoms, however mild and 
favourable they may appear, are absolutely deceit- 
ful. The inflammation in this case is extremely 
dangerous, and terminates commonly with the 
death of the patient. 



SEMEIOLOGY OP THE EYE. 



109 



The termination of peripneumony is almost 
always mortal, if the patients are tormented with 
violent palpitations of the heart, accompanied by 
an oppression of the breast and agony ; by swel- 
ling or paralysis of the arms ; if they throw them- 
selves with uneasiness from one side to the other in 
their bed • if the inflammation of the heart is united 
with that of the lungs; if the eye presents alter- 
nately an aqueous, troubled, and ferocious aspect ; 
or if it melts in tears, and finally, if there appears 
unexpectedly a hydrothorax or phthisis. Examine 
on this subject the classical works of S. G. Vogel, 
K. Sprengel, P. Franck, Conradi, Stoll, Quarin and 
Triller. 



Expression of the eye in inflammation of the liver* 
(hepatitis.*) 

It is remarkable that all kinds of inflammation 
of the liver are not constantly accompanied by ic- 
teric symptoms. 

When the convex side of the liver is inflamed, 
we remark a steady pain in the region of this or- 
gan, a pain which rises even to the neck. The 
lower belly is bent, and there exists, at the same 
time, a dry cough ; the pulse is firm and full, often 
easy, and more or less quick. 

The right side of the face is redder than the 
left, and the right eye is weakened at the begin- 



110 



SEME1GLOGY OF THE EYE. 



ning of the inflammation ; the eye appears lively 
and reddish, but the sclerotica is disturbed ; the 
looks of the patients are then gloomy and suspi- 
cious ; the mouth is dry, and heat and thirst ap- 
pear. The urine is redder, the patients begin to 
talk nonsense, they have a painful feeling at the 
point of the shoulder, or at the clavicles, and 
severe cramps in the right calf of the leg. It is 
impossible for them to sneeze, the patients suffer 
from a pulsation in the epigastric region, and are 
subject to cardialgia, cramps and hiccough. 

The signs of the inflammation of the concave 
side, are different from those of the inflammation 
of the convex side. We observe vomiting, a bit- 
ter taste in the mouth; the patients have spasmo- 
dic tensions in the precordial region. In this 
inflammation we observe distinctly the symp- 
toms of jaundice; the albuginea is of a saf- 
fron colour, the eye has a desponding look, the 
pupil contracted, the iris is of a brown yellow, 
and the veins engorged ; the saliva, stools and 
skin yellow ; the urine particularly yellow, with 
an aspect of red; the pulse slow, and the 
bowels are constipated. The patient complains 
of a load at the pit of the stomach, sometimes pain 
in the shoulder, with a feeling of burning inter- 
nally ; finally, the symptoms which distinguish the 
inflammation of the convex side of the liver 
appear. 

When the seat of the inflammation of the liver 



SEMEIOLOGY OF THE EYE 



111 



is established in the substance itself of this organ, 
the patients feel inexpressible anxiety, the pulsa- 
tion in the region of the liver is extremely violent, 
as is also the fever and the internal heat. The 
pulse is very slow ; the eye expresses an anxiety, 
and is especially brilliant in the evening and at 
midnight ; the pupil is contracted, the vessels of 
the iris are engorged, and of a red brown ; ordi- 
narily, the eye begins to become yellow a few days 
before the inflammation is entirely developed. 

When the inflammation is more deeply seated 
in the liver, the eyes begin to become yellow four 
days before ; the urine, at this period, is of a dark 
red, and after that the inflammation is manifested 
by a febrile chill ; the pain is violent. 

When the right lobe of the liver is inflamed, the 
icteric signs are not so distinctly manifested in 
the organization ; the eye has more of a brown 
aspect, and the patient cannot turn on the left side. 
When, on the contrary, the inflammation has 
reached the left lobe of the liver, which happens 
frequently in the West Indies, the patients arc 
attacked particularly with a great sensibility, pain, 
and tension in the region of the stomach. 

The icteric symptoms are visible in the urine, 
and particularly in the eye. 

The chronic inflammation of the liver is equally 
visible in the albuginea of the eye. The patients 
complain of a feeling of heat, dulness and heaviness 
in the region of the liver, as well as of obstinate 



112 



SEMEIOLOGY OF THE EYE. 



pain, which becomes more sensible when we touch 
the afflicted part. This inflammation also distin- 
guishes itself by a tumefaction of the liver, which 
sometimes becomes considerable ; to which symp- 
toms we may also add difficulty of lying on the 
left side, or on both sides, a feeling of oppression 
in the right shoulder, and pains in the right calf 
of the leg. The face is earthy, pale or yellowish; 
the eye is not of so pure a yellow as in the hepa- 
tic ague, but rather of an unclean yellow, as if it 
were dyed with gamboge : the eyeball is a little 
dilated ; the iris is not much bent — its arteries are 
flabby and of a pale red. 

The looks of the patient are dull ; he is sad. 
diffident, and thoughtful. Then follow pains in 
the stomach, and imperfect digestion, a slight fever 
which is almost imperceptible, and often obstinate 
ulcers in the legs. The mind is, at the same 
time, affected; the patient is entirely dejected, 
sometimes even to despair. The urine is of a 
saffron colour, often of a dark red, and stains the 
linen yellow. 

It results from the characteristic symptoms 
which we have just mentioned, that the inflamma- 
tion of the liver, acute as well as chronic, appears 
in the eyes under different shapes. We remark 
that in the acute, the fever disappears sooner than 
the fixed pain and icteric signs of the face, eyes, 
and skin. 

The termination of the inflammation of the liver 
may be observed by the diminution of the icteric 



SEMEIOLOGY OP THE EYE. H3 

symptoms. If the inflammation becomes entirely 
reduced, the yellow tincture of the eyes and face 
diminishes, the fever and settled pain in the 
region of the liver abate, and finally cease altoge- 
ther. The urine loses at the same time its black 
or dark yellow colour; the constipation of the 
lower belly ceases also, and the stools, until then 
white or grayish, begin to turn yellow ; the op- 
pression and feeling of repletion in the epigastric 
region also disappears, as well as the swelling and 
insensibility; the feverish heat, the exacerbation 
towards morning, the gastric symptoms and thirst 
diminish, and the patient feels himself generally in 
a better situation. 

The happy issue of the inflammation of the 
liver is doubtful if the excrements resume not 
their natural colour. It was thought a very fa- 
vourable symptom for the termination of this 
disorder if there appeared some pains in the 
spleen ; but practice has taught us, that this symp- 
tom was absolutely false and deceitful. Bleeding 
at the nose can be regarded as a happy omen 
only when the icteric signs disappear at the same 
time. 

Should this not be the case, however, and the 
symptoms generally increase rather than diminish, 
and the inflammation appear to be augmenting, 
this symptomatic bleeding at the nose indicates 
that there exists an accumulation or dissolution of 
blood in the veins, which, according to our obser- 
vation, frequently becomes mortal. 

15 



114 SEMEIOLOGY OF THE EYE. 

After a critical and beneficent bleeding of the 
nose, the eye commonly becomes more calm; it 
loses its ferocious looks, the yellow colour turns 
paler, and it becomes more and more clear and 
white. 

But if the inflammation of the liver terminates 
by suppuration, the icteric symptoms do not dis- 
appear entirely ; they only diminish a little. It is 
in these cases especially that we have paid the 
greatest attention to the eyes, and experience has 
taught us to expect to meet with the following phe- 
nomena exhibited in the changes of the eye. 

1. The yellow colour of the eye never disap- 
pears entirely ; it diminishes a little for a time, but 
commonly returns after one or two days. 

2. During the period of suppuration, the eye is 
not of so clean a yellow, as during that of the in- 
flammation ; it is rather of an unclean or brownish 
yellow. 

3. We have besides remarked upon some parts 
of the eye, some striae or threads of mucus, which 
appear to be quite thick ; the eyeball was a little 
more dilated during the period of the inflamma- 
tion, and the iris appeared slack or relaxed. 

Such are the symptoms which we have con- 
stantly observed in the eyes of patients, during the 
suppuration of the liver. At the same epoch the 
violent pain of the local affection in the right side 
ceased, but there still continued in the affected 



SEMEIOLOGY OF THE EYE. H5 

part a sensation of fulness. The exacerbations 
were accompanied by slight shiverings ; the urine 
was brown, troubled, and dark in colour, or had a 
reddish ground ; the stools were liquid, tarnished, 
and fetid; the patients then had a pulsative pain, 
very sensible to the touch ; the vital powers dimi- 
nished rather than augmented, appetite was want- 
ing, and thirst increased. The patients perspired 
much; the whole right side was benumbed and 
insensible. A severe pain was felt in the right 
shoulder, and an almost insupportable pain seized 
the legs, especially the calves. 

We may foresee the termination of the inflam- 
mation of the liver in scirrhus, if the fever that 
accompanies the inflammation is not very strong, 
and rather remittent ; if the exacerbations are not 
too violent, if the progress of the inflammation i« 
not active but rather slow, if the heat is not very 
burning, nor the topical pain very acute, the affected 
part, however, being somewhat painful. We may 
particularly foretell its termination in scirrhus, if 
after the seventh or fourteenth day of the disease 
the fever is not too strong, diminishes sensibly, and 
is scarcely marked during the exacerbations; if 
the eyes preserve their yellow colour, if the eyeball 
does not change, and the look is gloomy and ab- 
stracted ; if, moreover, the patients are sad and 
dejected, if the feeling of pressure in the right side 
continues to take place, if the stools are not regu- 
lar, if the digestion suffers, if the excretions are of 
a grayish colour, clayey or bilious, if the appetifr 



116 SEMEIOLOGY OP THE EYE. 



is deranged, if the precordial region is tumefied, if 
the respiration is constrained, if the right foot or 
the whole right side is swelled, if the urine is trou- 
bled and flows scantily, and presents a reddish 
ground, we cannot, after these signs, doubt of the 
inflammation of the liver. 

To the symptoms we have just mentioned, we 
may add — constipation or the flux, piles, consump- 
tion, and decay. 

If the inflammation of the liver terminates by 
adhesion, for example, the liver contracts an adher- 
ence with the diaphragma, the peritoneum, or with 
any other organs of the lower belly ; in these cases 
we see no icteric symptoms, and it is very difficult 
to form our judgment upon this termination. 

We may, however, admit adhesion to have taken 
place, 

1. If the patient casts sad looks around him 
similar to a person overwhelmed by profound 
grief; if the eye is deeply concealed in the orbit, 
and if the sclerotica is rather aqueous than pure 
and dry. 

2. If the inflammation of the liver terminates 
without critical evolutions, and we observe neither 
scirrhus nor suppuration. 

3. If all the functions of the liver, and of the 
biliary system operate naturally, and the patient is 
tolerably well, and complains only of a permanent 
feeling of heaviness in the region of the liver, if at 
the same time respiration is a little painful, and if 



SEMEIOLOGY OF THE EYE. 



117 



the patient has a painful sensation when we touch 
the place where the seat of the inflammation of 
the liver was. 

The inflammation of the liver may also terminate 
by gangrene. The phenomena of the gangrene 
are the following : the topical pain as well as the 
fever disappear suddenly, the lower belly is swelled, 
the excretions have a fetid odour, the pulse be- 
comes trembling, short, and irregular : delirium 
appears unexpectedly, accompanied by extreme 
weakness, cold sweats, cold extremities, and the 
hippocratic face ; the clear yellow of the eye turns 
brown ; the eye itself takes an unquiet and fero- 
cious air. 

We also have found at this epoch something 
particular and characteristic in the iris ; the extre- 
mity which concurs to form the eyeball, appeared 
to us extremely changed in the first hours of the 
gangrene ; the eyeball is more contracted than 
dilated, but it becomes larger, and even in the last 
moments of life it is not exactly round, but irregu- 
lar and dented. 

It is without doubt useless to remark, that vio- 
lent inflammations, which show themselves such 
from the very beginning, which attack the liver 
entirely, and which are not well treated, terminate 
often in gangrene ; which often appear also when 
the hepatitis assumes suddenly the character of 
the typhus, or is complicated with the putrid dia-! 
thesis. 



)1S SEMEIOLOGY OF THE EYE. 

According to Marcus, it is especially in autumn 
that this disease is subject to degenerate into gan- 
grene. 

In the acute inflammation of the liver this dan- 
gerous inflammation happens commonly the se- 
venth or fourteenth day after a violent anger. 

We do not speak here of inveterate hepatitis ; 
the prognosis of the inflammation of the liver is 
relative, and must be influenced by the location of 
the inflammation in the organ itself, and different 
coincident circumstances. Associated with sy- 
nochus, and during winter, hepatitis, although 
very violent, is however less dangerous than when 
it occurs at other seasons, and with other com- 
plications. United with synochus in summer, it 
ss very decidedly dangerous, and its termination 
involved in doubt and uncertainty. The greatest 
danger exists in autumn, when the disease is united 
with typhus. 

The inflammation of the liver may become dan- 
gerous, if the upper and convex part of the liver is 
violently attacked ; it is less dangerous, however, 
if the inferior and concave part is attacked. In 
the first case, the inflammation is more violent, and 
has a quicker progress ; it is very dangerous in the 
first period. In the second case, on the contrary, 
it is more mild and less rapid in its progress, and 
only when it may be productive of other trouble- 
some affections, and in some cases even of fatal 
consequences, becomes dangerous in the last 



BEMEIOLOGY OF THE EYE. {\g 

periods. The prognosis, therefore, in this species 
of hepatitis is more difficult and less certain. 

Marcus says: " The prognosis of the hepatitis 
44 is more or less favourable according to the con- 
" stitution of the body, the temperature of the air, 
44 and the concomitant fever. Young and plethoric 
44 persons are more violently attacked ; the danger 
44 appears greater, and it is really so if the patient 
44 be not carefully treated, but the sickness termi- 
44 nates in a little time, without leaving fatal con ■ 
44 sequences, if proper remedies are prescribed.— 
44 With persons of a bilious or atrabilious consti- 
44 tution, or with those who are weak, the attacks 
44 are, it is true, less violent at the beginning, and 
44 the sickness takes a slower step, but the conse- 
44 quences are more serious, especially if the organs 
44 and the functions of digestion, as it often happens. 
44 are disturbed." 

According to our observation, the prognosis of 
the inflammation of the liver is less dangerous in 
winter, when it attacks young and strong persons, 
because the inflammatory symptoms commonly 
terminate with the critical evolutions, the sclerotica 
becomes clear, the ferocious looks become mild 
and peaceable, the icteric symptoms disappear, the 
saffron colour of the urine changes to lemon yel- 
low, with a little sediment, constipation ceases, the 
local pain in the region of the liver, with feelings 
of repletion, diminish by degrees ; the tongue 
becomes clear, the appetite and strength return, 
and the fever ceases. These changes are perma- 



120 



SEMEIOLOGY OF THE EYE. 



nent, and there is no relapse, provided the patient 
does not commit any errors in diet, and has the 
benefit of correct medical advice. 

For additional information on this subject, the 
reader may consult the writings of Stoll, Van 
Swieten, P. Franck, S. G. Vogel, A. G. Richter, 
K. Sprengel, Conradi, Reil, Clark, J. G. Bovel, 
Marcus, and Raimann. 

Expression of the eye in different diseases of the 
vegetative system, presented in an aphoristic 
manner. 

In the beginning of a gonorrhoea, in the measles 
and catarrhs, we remark particular phenomena in 
the eye. 

In the first period of gonorrhoea the albugi- 
nea is at first of a pale red, aqueous, and after- 
wards unclean. In chronic and inveterate go- 
norrhces, the eye appears a little wandering, and 
covered in some places with mucous striae. The 
eyeball is rather dilated than contracted, and the 
iris is relaxed. 

In simple catarrh the patient begins to sneeze 
strongly, and a' sharp humour runs from his nose in 
proportion as the disease progresses ; this humour 
often disappears, and a dry rheum appears in its 
place. The eyes begin to burn, they fear the light, 
and are a little red ; tears appear in great abun- 
dance, and are sharp. Sometimes we observe even 



SEMEIOLOGY OF THE EYE. 



121 



true catarrhal ophthalmia. We also often ob- 
serve the eyelids closed on account of the great 
sensibility of the eye to light. 

In the second period of the catarrh, when the 
patient begins to spit, which announces a local 
crisis of the catarrh, this critical motion is also to 
be seen in the eyes, for if they are affected in this 
disease, we will also remark the formation on the 
eyelids and glandulse meibomii of a thick mucus. 

The eruption of the measles is preceded by a 
fever with symptoms of a catarrh. A dry and 
spasmodic cough, frequent sneezing, running of 
tears, and of sharp humour from the nose, are 
characteristic phenomena and deserve much at- 
tention. 

In the period of the irritation, when the fever 
declares itself (stadium irritationis vel febrile,) it 
resembles the catarrhal fever ; towards night there 
appear exacerbations, which augment progres- 
sively until the moment of the eruption of the 
measles. 

We remark, at the same time, a violent cough, 
frequent sneezing, hoarseness, headache, especially 
above the eyelids, sensibility of the eyes to light, 
itching, pains, redness of the eye, and a sharp hu- 
mour running from the eyes and nose. 

During the epoch of the eruption (stadium 
eruptionis) if, after the third exacerbation of the 
fever the measles appear on the face, the breast, 
and the arms, and afterwards on the lower belly, 
the legs and the back, the face is always swolu. 

16 



122 



SEMEIOLOGY OF THE EYE. 



and the eye is not of a bright but rather of a pale 
red, and in the malignant measles it is aqueous and 
unclean. 

It is only when the measles are accompanied by 
a very strong inflammatory fever, that the eyes 
appear very red and sensible to light ; notwith- 
standing, this, the cough continues always, and in 
in these serious cases the cough, fever, and the op- 
pression of the breast augment progressively after 
the eruption. 

The exanthem appears about three days after 
the eruption, and disappears very slowly. In this 
epoch (stadium florescentiae) we see the colour of 
the exanthem change; it turns pale, yellow, or 
sometimes brown ; the spots of the measles dis- 
appear, and the swelling of the face and eyelids 
diminishes ; the eyes look dejected, they are more 
red, and the iris appears pressed down. In mea- 
sles of a mild character, the cough and fever also 
cease very soon. 

At the epoch of the desquamation (stadium des- 
quamationis) the eye assumes its common aspect ; 
however, we observe something tarnished in it, 
mixed with some brightness in the sclerotica ; but 
the ophthalmia and the fever disappear entirely, 
and the crisis, that consists in an augmented pers- 
piration, in urine more abundant with a sediment, 
or finally in a diarrhoea, brings back health. 

In the anomalous measles, or in those which have 
a nervous or putrid character, we observe very 
dangerous symptoms. They are : the powers sud- 



i v; > 

S3EMEIOLOGY OF THE EYE. 123 

denly diminished, despondency, chills, insupporta- 
ble headache, no sleep, and dyspnoea ; the eye is 
red and brilliant, and cannot support the light ; the 
pupil is more contracted; the pulse is irregular, 
small, and hard. The fever continues with vio- 
lence after the eruption of the exanthem. 

The measles eruption commences soon after the 
second or third day ; it is abundant over the peri- 
phery of the skin, but the spots are pale over the 
surface, unequal, and mixed with other kinds of 
eruptions. It is soon after attended with cardial- 
gia, with vomiting, with pneumonia or angina, with 
pain in the deglutition ; and, if the disease makes 
progress, lethargia, convulsions, subsultus tendi- 
num, and often, after the fifth or sixth day, death 
finishes the horrible sufferings of the patient. 

In this pure nervous period, the eye is ferocious, 
inconstant, brilliant, but little inflamed, and more 
aqueous, the albuginea has a brilliant aspect : ne- 
vertheless, at different periods of the day we have 
found the patient so weak, that twenty-four hours 
in advance we could foretell with certainty a ner- 
vous apoplexy. 

In forming the prognosis, we must take into 
consideration at the same time, the deranged con- 
dition of the urine, and the irregular, quick, and 
small pulse. 

In the putrid measles we observe most of the 
symptoms which we have just described ; they in- 
dicate great weakness in the patients, and an in- 



124 



SEMEIOLOGY OF THE EYE, 



clination to the decomposition and colliquation of 
the humours. 

The measles itself presents a colour of reddish 
blue, and mixed with petechia? and miliary eruption. 
The urine resembles brown beer, or white beer which 
is thick ; the pulse is slow, trembling, frequent, and 
unequal : hemorrhages of the nose, lungs, anus or 
uterus; very fetid diarrhoea, accompanied with 
tenesmus, colliquatives, and sweats announce great 
danger, and often death. 

In this kind of putrid measles the eye is inani- 
mate, the albuginea dusty, often of a brown yellow 
colour, the iris is diminished, and the pupil dilated 5 
the glandulse meibomii are inflamed and in suppu- 
ration ; in a word, the eye offers absolutely the same 
appearances we have described in the putrid fever. 

Our readers can consult on this subject the writ- 
ings of Rusch, Hoffmann, Wedekind, Fordyce. 
Franck, Horn, De Haen, Reil, J. P. Franck. 
Mezger, Richter, Vogel, Jahn, Henki, and Feiler. 

The ancient and modern physicians have paid 
great attention to the different changes we observe 
in the eyes of persons attacked with worms. We 
purpose to avoid entering on a discussion on the 
formation of worms, and shall pass by in silence 
the writings of Goetz, Jordan, Brown, Hecker, 
Schaeffer, Rusch, Weikard, Jahn, and Henki ; but 
we feel it our duty to recommend the ingenious 
ideas of the celebrated Blumenbach on this subject.* 



* Blumenbach's Naturgeschichte. Gottingen 1 792, s. 411 . 



SEMEIOLOGY OF THE EYE. 125 

The most constant symptoms which announce 
the presence of worms in the intestinal canal are 
the following : The face is pale, there is frequent 
change of colour in it without any internal motive, 
a frequent itching of the nose, an abundant run- 
ning of saliva, a disagreeable odour in the mouth, 
especially by children who are fasting, an inquiet 
sleep, a gnashing of the teeth during sleep ; the 
pulse unequal, irregular, often intermittent ; an 
abundant and aqueous urine, stools irregular, often 
diarrhoea, often constipation ; the appetite derang- 
ed, sometimes excessive, sometimes diminished: 
thirst, the belly swollen, colics, an eruption around 
the mouth, itching of the anus, a frequent inclina- 
tion by children to lie down on the abdomen, &c. 

To establish a precise and perfect diagnosis we 
must observe the eye in conjunction with the other 
phenomena of the organization, especially when 
the moon is full and on the decline. Experience 
has sufficiently proved to us that at this epoch 
the symptoms of worms are more evident and 
decided. 

In diseases from worms we remark particularly 
the dilatation of the pupil : the eye offers a more 
aqueous aspect, the albuginea a milky and dull 
appearance ; we often observe a movement of os- 
cillation in the eyelids, and the eyes are surrounded 
with blueish circles. We have observed the same 
appearance several times in a chronic ophthalmia, 
with other symptoms of worms. The change of 
the eye and the dilatation of the pupil in diseases 



126 



vSEMEIOLOGY OF THE EYE. 



from worms, prove to us the affection of the sen- 
sibility in the vegetation of the organization. 

It is not less important to consider the ex* 
pression of the eye in the different periods of 
whooping cough. In the first period, the eye cor- 
responds in appearance with that stage of catarrh ; 
the eyes are dull, the albuginea is often of a rose 
colour, especially when the whooping cough has a 
pure inflammatory character, and when the gene- 
ral constitution is phlogistic, and the eyes are often 
inundated with tears. We remark a cough which 
does not fatigue much, sneezing, slight chills, 
horripilations, little heat, the sleep deranged, des* 
pondency. 

This period exists during violent epidemics from 
three to four days, but ordinarily from eight to fif- 
teen days. 

In the period when whooping cough is formed, 
the face is swollen red, and sometimes brown, the 
eyes are prominent, the little veins of the albuginea 
engorged with blood, the whole conjunctiva be- 
comes sometimes as red as blood, the lips are 
swelled and blue, the paroxysms violent, almost 
occasioning suffocation. 

We have seen hemorrhages from the nose, the 
mouth, the lungs, the ears : after the paroxysm a 
total intermission takes place ; the cough is often 
accompanied with vomitings, when the contraction 
of the diaphragm is too strong or too violent, from 
a succession of spasmodic oscillations of the nerves 
of the diaphragm. 



SEMEIOLOGY OF THE EYE. 127 

In the third period the disease begins to diminish. 
This diminution is distinguished especially when 
the cough loses its violence and convulsive nature. 
The danger of suffocation exists no longer, and we 
hear no more that peculiar sound which particula- 
rises this cough. 

In this period, it is true, the aqueous aspect of 
the eye diminishes. The most characteristic symp- 
toms, and those which exist during this whole pe- 
riod, are the blue circles around the eyes. This 
period often lasts several months unless the best 
succours of the art are afforded ; and frequently 
ceases sooner by observing an exact regimen than 
by other remedies. 

But if secondary affections of the whooping- 
cough supervene, local or general, the eye is dull, 
and deep in the orbit ; the iris of a red brown ; the 
albuginea dull and dusty, and the wrinkles of the 
eyes filled with mucus. 

These phenomena are constant signs of danger 
in the secondary diseases of the whooping-cough* 
and ordinarily announce, according to our experi- 
ence, the incurableness of the disease, and the 
proximity of death. (See further details in the 
writings of Rosenstein, Cullen, Hufeland, Schaeffer, 
Paldamus, and Marcus.) 

In all chronic diseases of the vegetative system, 
which are the seat of the second polarity, the eyes 
have a suffering and depressed air, and the albugi- 
nea is more aqueous, and more or less covered with 
mucosities.The same occurs in suppurative phthisis. 



128 



SEMEIOLOGY OF THE EYE. 



suppuratives of the lungs, kidneys, and muscles of 
the loins, as also in phthisis of the intestines, of 
the uterus, and of the liver. Nevertheless, in this 
last phthisis, the eye is of a dusty or brown yellow, 
covered with mucus, and the iris of a brown red. 

Expression of the eye in some diseases in which the 
sensibility, (or nervous system?) is particularly 
affected. 

In hypochondriasis, where the digestion and the 
sensibility of the digestive system are affected, the 
eye is dull; it announces misanthropy and defiance, 
and the patients often complain of vertigo; they see 
objects double ; they seem continually to see flies, 
or to have a mist before their eyes ; they perceive 
sometimes a burning or a tingling in the ears. In 
one word, we can tell that the eye of a hypochon- 
driac is a true mirror of the distress of his mind ; 
of the melancholy, the sadness, the fear, the inqui- 
etude and despair, which beset, at different epochs, 
the existence of these unfortunate sufferers. 

When the liver, the bile, and the system of the 
vena porta are affected at the same time, the albu- 
ginea is dusty, or of a saffron colour ; but when the 
hypochondriasis is occasioned by material causes, 
such as obstructions, and accumulations of blood 
in the abdomen, the complexion of the patient is 
yellow and pale ; the eye is inanimate ; the albugi- 
nea tarnished with yellow, and deep blue circles 
are observed around the eyes. 



SEMEIOLOGY OF THE EYE. 



129 



In epilepsy, the eye presents a particular aspect : 
in idiopathic and symptomatic epilepsy, the counte- 
nance is inanimate ; there is also a certain fixedness 
of expression. When this disease has continued 
for a considerable time, it affects the brain, and 
disturbs the intellectual faculties, and the eye has 
entirely the appearance of that of a simpleton, 
and is inanimate. 

In those cases of epilepsy in which were found 
after death, exostoses and other organic defects in 
the brain, arising from external violence on the 
head, the eye was always inanimate and suffused, 
and the pupil extraordinarily dilated. In pede- 
rastes, onanists, and tribades, when epilepsy is 
caused by this hideous vice, the eyes are dull, 
aqueous, and surrounded with blue circles. The 
same symptoms are observed in epilepsy occasion- 
ed by worms : but in this case, an attentive exami- 
nation, and the actual presence of worms, conduct 
us to the true cause of the disease. At the time 
the blue circles appear, the pupil is dilated ; and 
before the access of epilepsy, the eyes roll with 
fury in the head. 

The wise Stoerck justly observes on this subject: 
" Admodum frequenter nihil omnino observant et 
" hilares perfectoque sanitate gaudere videntur ; 
w subito vero oculos rotant, aut in facie pallescunt, 
" et multis prsesentibus, nemine opinante, conci- 
- 4 dunt, ut exinde non parvus adstantibus incutiatur 
- 4 terror : nec pauca exstant exempla, ubi, excitato 
; tali terrorc. prsesentcs antehac sanitate illibatn 

17 



130 SEMEIOLOGY OP THE EYE, 

" praediti eodem modo, difficulter admodum posthae 
" curando, correpti fuere." 

On the importance of examining the eyes and their 
expression, in medico-legal inquiries ; and on the 
eyes of accused persons in criminal cases, and the 
expression manifested in their eyes and face. 

We are now about to enter upon a subject which 
is of the greatest importance to the judge, the law- 
yer, the physician, and the philosopher. The au- 
thor particularly wishes that it may attract the no- 
tice of the first two, and he will feel himself flattered 
if it meet their approbation. 

During my residence at Strasburg, in France, I 
was several times requested to be one of a jury in 
the court ; and I have myself had occasion to ob- 
serve with strict attention, the looks of the accused, 
during the interrogatories, and I have found in 
many cases that the state of their mind was exactly 
painted in their eyes. Falsehood was represented 
by uncertain and wandering looks ; the internal 
conviction of guilt was portrayed in the eyes by- 
timidity and dull looks, which changed to smiling, 
but deceptive expressions of, the countenance, 
mingled with the torments of conscience. After 
having communicated our observations to the pre- 
siding judge, ( juge instructeur) the result was con- 
firmed by the guilt of the accused, whose subse- 
quent confessions verified the indications of his 
countenance. 



SEMEIOLOGY OF THE EYE. 131 

The celebrated Eshenmayer says : # " The con- 
M science is an admirable faculty in man. It is a 
44 secret tribunal, which has jurisdiction over our 
44 individual selves only, and makes us responsible 
" for our actions, and even our thoughts. In com- 
" mitting bad actions, man is in fear of himself ; 
" he is punished by repentance, and tortured with 
" remorse. The criminal who conceals himself, is 
" pursued day and night by his conscience : every 
44 hour in the night the sound of the clock awakens 
44 in him the recollection of his crime. Tranquillity 
u cannot return to his breast. It is in vain he 
" benumbs or intoxicates himself with joys and 
u pleasures : his awaking from them is terrible. It 
44 is astonishing to see him affrighted at his own 
" image, when he beholds it in the mirror of his 
" conscience, disfigured by crimes and vices ! Man 
" is really a double being; the criminal and judge; 
" culpable, and at the same time his own accuser. 
u What is more astonishing, is, that we ourselves 
" are premonished and cautioned of that which 
44 is not praiseworthy in our sentiments and actions. 
44 Psychology recognises this double being, and 
44 admits the existence of conscience as a fact, and 
44 places her in the first rank in the series of the 
44 passions directed towards a celestial end. Con- 
44 science teaches us that which is true and just. 



* C. A. Eshenmayer, Psychologie, in drey Theilen, als empirische, 
reine, und angewandte. Bey J. C. Cotta, 1817. 



132 SEMEIOLOGY OF THE EYE. 

44 Conscience furnishes us with a certain guide for 
44 our actions ; her voice is heard in the most pro- 
44 found recesses of our heart ; it is in vain we at- 
44 tempt to entrench ourselves behind sophisms and 
44 refined subtilties — it is impossible for us to elude 
" the censure of her mysterious tribunal. Her pow- 
44 er, superior to truth and justice, maintains her 
44 authority over reason and volition. She sways 
44 our thoughts and our actions ; and reason, with 
44 all her principles and all her logic, can do nothing 
44 against this secret and elevated judge. Con- 
44 science, in a moment, resolves all the doubts 
44 which reason and prudence can offer." 

These psychological reflections on conscience, 
made by the judicious Eshenmayer, are daily con- 
firmed by experience. We cannot refuse to admit 
that the different movements of conscience and 
remorse are distinctly traced in the ocular expres- 
sion, and painted in the looks of the face. 

We Lave before mentioned that great part of the 
affections and sufferings of the mind are represent- 
ed in the eyes, and produce corresponding changes 
in the looks. Can we refuse to admit, by analogy, 
that the alterations produced by conscience in our 
mind are retraced in the language of the eye ? 
Conscience and its monitions can never acquire 
real value in psychology and medico-legal inquiry, 
unless we study with precision and sagacity the 
changes and the language of the eyes, which can 
alone conduct us with certainty to the knowledge 
of the inward stragglings of the conscience ; it is 



SEMEIOLOGY OF THE EYE. 13^ 

not sufficient that the physician should merely 
direct his attention superficially to apprise himself 
of the perturbed state of the mind ; he must also 
attend to the extraordinary actions of the patient. 
The secret workings of the conscience must be 
determined and judged by the play of the features, 
the aspect of the eye, and the expression of the 
face. It is then only that psychology can attain 
the highest degree of scientific truth, when we be- 
gin to distinguish accurately the phenomena of the 
eye, and to compare them synthetically with the 
internal movements of the mind. 

Conscience demonstrates to us truth and justice ; 
but the knowledge and reality of this positive fact 
cannot be acquired but by objective representation. 
All the affections of the mind arise originally from 
facts and experience. How could we arrive at the 
result, were it not from the assertions, the actions, 
and especially the aspect and expressions of the 
face of a tormented being under remorse <t>£ con- 
science ? As we cannot distinguish the expression 
of the masterpieces of a Titian, of a Correggio, of 
a Rubens, of an Albert Durer, and of a Vandyke, 
by their imitations or copies, nor by ideal construc- 
tions only; but we must have studied, or ourselves 
have often seen the finished productions of those 
great masters, before we can learn to distinguish 
their original genius, and to recognise it directly 
by the fineness and delicacy of their pencil, by the 
brilliant and admirable play of the colours, or by 
the expression of sentiments and passions: in 



134 



SEMEIOLOGY OF THE EYE. 



like manner psychology can only establish its basis 
by the different aspects of the face, the expression 
of the eyes, and other physical acts. 

It is without doubt necessary in a science so 
difficult, that a judicious and prudent observer 
should unite experience to genius, firmness of cha- 
racter to philanthropy, and a religious spirit to an 
indefatigable activity. 

Conscience exercises her empire over criminals 
decorated with purple, as well as over malefactors 
covered with rags. 

Neither the principles of an artful and criminal 
politician, nor selfish eloquence, can stifle in the 
great of the world, the terrible voice of justice 
and truth. 

Open the records of history, and you will be 
convinced of the truth of our assertion : you will 
find that an avenging divinity is manifested to kings 
by the voice of conscience. We communicate 
the following fact : 

" Nero, occisa matre Agrippina per anicetem. 
* 4 nec sceleris conscientiam, quamquam et militum, 
" et senatus populique gratulationibus confirmare- 
" tur, aut statim, aut unquam ferre potuit : saepe 
" confessus exagitari se materna specie, ver- 
" benbus furiarum ac telis ardentibus." — Dion, in 
Nerone. 

The remorse of conscience traces, in the most 
striking manner, the impress of crimes in the eyes 
of assassins, and of the common criminal. The 
eyes of these are dull, and turn with fury in the 



SEMEI6L0GY OP THE EYE. 135 

orbit ; their crime is painted on their forehead, and 
the superior eyelids, and the eye itself. Remorse 
wrinkles their forehead, the eyelids nearly cover 
the eyes, which exhibit timidity, defiance, dulness, 
inquietude, trouble, and anxiety ; sleep flies their 
eyelids, and despair unhinges the mind. 

— " Invigilant animo, scelerisque patrati 

" Supplicium exercent curse, tunc plurima versat 

" Pessimus in dubiis timor." 

Slatii Thebaid. lib. in. 

It will perhaps be objected to us, that among 
persons familiarised with crime, and who make a 
sort of boast of excelling in it, the voice of con- 
science does not betray itself; that neither by their 
actions, nor their traits of countenance, nor by the 
expression of their eyes, can we perceive among 
these depraved men any trace of conscience. 

But this objection is entirely destitute of foun- 
dation, and we reply that it suffices to proceed in 
psychology, with the design of being convinced of 
this incontestable axiom of Eshenmayer, that " it 
" is impossible to remove the criminal from the tribu- 
" nal of his own breast" We would advise the 
examination and observation of such men with 
attention, and without their even suspecting it. — 
That sparing no exertions, we should speak to 
criminals at different hours of the day, especially 
in the evening, or when night spreads her dark 
and frightful veil, and even at midnight, and listen 
at the doors of their dungeons, and we would be 



136 SEMEIOLOGY OF THE EYE. 

convinced that there are moments which exact 
groans and involuntary sighs from the most har- 
dened and abandoned, and that they cannot suc- 
ceed in stifling the voice of conscience. 

After these arguments and reflections on 
conscience, you will observe how necessary it is 
to pay more attention, and to attach more import- 
ance to the plastic alterations of the features of 
the face and expression of the eye in the researches 
of legal medicine, and even of opening of the 
bodies of persons poisoned or killed, than has 
heretofore been done. 

This examination deserves particular attention, 
if we presume that the guilty person is in the house 
or in the room where it takes place. 

Under this consideration, it is necessary that not 
only the officers of justice, but also an expert phy- 
sician, examine with sagacity, but at the same time 
with much prudence, the conduct of the persons 
present. If they remark, whilst they proceed to 
examine the corpse, an individual who appears 
restless, whose looks are wandering and uncertain, 
who shows, sometimes an extraordinary activity, 
sometimes calmness, and then an affected sadness, 
there is much probability that this man is the 
guilty person, and we may say of him : " Hie ille 
" niger est," or " the eyes betray you." 

However, it will be always prudent for the judge, 
physician, and psychologist to take into conside- 
ration. 



SEMEIOLOGY OF THE EYE. 137 

1. The former state of the character or mind 
of the accused, for there are persons, for example, 
who during all their lives, have something fearful 
and anxious in their manners, and whose timid 
looks are always cast towards the ground. 

2. If the individuals in question have con- 
stantly experienced an aversion and an extraordi- 
nary fear at the sight of a dead person, which 
happens often to many persons, who consequently 
will assist with more uneasiness at the opening of 
the corpse. 

3. It is necessary to ascertain, whether before 
the accident they had a quiet and composed cha- 
racter, or if this disposition was only observed 
during the juridical examination. 

4. We must scrupulously examine the whole 
moral and physical internal emotions of these indi- 
viduals, and compare them with the particulars 
which we have just described. 

The evidence thus furnished is not in truth in 
conformity with the rigid exactions of criminal 
law, but only probable, or uncertain, or collateral 
evidence. But has not experience often proved 
to us, that conjectural proofs have frequently led to 
conviction ? 

The celebrated lawyer Feuerbach says : # " A 



* D. P. G. A. Feuerbach, Lehrbuch des gemeinen in Deutschland 
gultigen peinlichen Rechts. Funfte verbesserte auflage- Giesser 
1812. S. 479. und 480. 

18 



|38 SEMEIOLOGY OF THE EYE. 

44 fact is certain, when we have obtained all the 
" motives of credibility, which, according to our 
" manner of seeing, constitute their reality. 

44 Incertitude has three degrees : 

44 1. Probability — whether there are more motives 
;4 for, than against the truth of a fact. 

44 2. Doubt — whether the motives for, or against. 
44 are of equal value. 

44 3. Unlikelihood — whether there are less mo- 
44 tives for, than against them. 

44 The state of the mind in probability and doubt 
44 constitutes suspicion, which we must never con- 
44 found with presumption. We presume a thing 
44 when we admit the possibility of its likelihood? 
44 without even explaining the motives of our opi- 
44 nion. Presumption is preceded by conjecture,'" 
&c. 

We may consult on this subject : Thomas Noni 
d'Alteniensis, L. F. Puttmann, Weindler, Hanns 
Ernst von Globig, Pagano, and Feierlein. 

We cannot refrain, after what has been stated, 
from again inviting the attention of the honourable 
judges, lawyers, physicians, and psychologists, to 
the eyes of the accused, and requesting them to con- 
sider attentively our ideas upon conscience, and 
the manner in which it is displayed in the eyes 
and face. 



SEMIOLOGY OF THE EYE. 



139 



Description of the eyes, showing the difference be- 
tween those of a woman and those of a man. 

In woman sensibility generally predominates, 
and reason is subordinate to it ; whilst, on the con- 
trary, in man it is reason that predominates over 
sensibility, and strength is more expressed: there- 
fore the eye in woman, especially when the mind 
is calm, shows sweetness of temper, mildness, and 
amiability, whilst in the eye of man reign firm- 
ness of character, resolution, seriousness and 
strength. But in agitation, or tempests of the soul, 
we perceive also the greatest expressive vivacity in 
the eye of woman. 

When it is animated by anger, envy, or madness 
to domineer, neither the mind nor reason can 
soften it. In these circumstances it shows itself 
more unruly and more terrible than the eye of man, 
and the infernal furies seem to have established 
their residence in the eyes of women governed by 
these passions. 

Without doubt, in these sorts of mimic expres- 
sion of the eyes, temper, individual organization, 
the mode of life and education of the individual 
have a great influence, a circumstance which psy- 
chologists and physicians ought to observe with 
discretion in order to pay due regard to it. 



140 



SEMEIOLOGY OF THE EYE 



On the effects of different poisons on the eye. 

We have explained that the intellectual faculties 
and the affections of the mind, in acting from 
the central organ of the nervous system produce 
different effects upon the representation of the 
eyes ; and we also have shown how the different 
motions of the soul and mind are to be seen in 
the eye. 

To this representation, at once ideal and real, 
we must oppose a secondary one, determined by 
objects which influence the eyes either indirectly 
through the medium of the organization, especially 
on the sphere of the digestive organs, or indi- 
rectly belonging to the eye itself, and which 
produce alterations in its action, or in its appear- 
ance. 

The first case comprehends the metamorphosis 
produced by a free and intuitive activity, and by a 
vitality influenced by the soul, while the changes in 
the second case are the effect of different objects 
of the physical sphere of the organization over 
the sensitive organs of the eyes, which are so en- 
tirely changed under these circumstances as to 
appear entirely different from the natural state. 

We are now to consider the effects produced on 
the eyes by the poison of arsenic. 

Of all mineral poisons, arsenic is the most violent 
in its effects. The most celebrated physicians 



SEMEIOLOGY OP THE EYE. ^4 j 

tiave carefully noticed the phenomena which we 
observe in the organization after taking different 
doses of arsenic. 

It is especially in modern times that exact ob- 
servations have been made on this subject. With- 
out adverting to the ordinary symptoms which 
result from the poison of arsenic, we shall restrict 
ourselves to fixing the attention of physicians to 
the symptomatic changes of the expression of the 
eye, and of the secondary effects which arsenic 
produces, especially on this organ. An inexpres- 
sible fear and horror are painted in the eyes; they 
are shining and brilliant, and the looks are feroci- 
ous, timid and fearful ; the eyes start from their 
orbits ; the patient desponds, he does not see and 
does not attend to surrounding objects ; the eyes 
aru bathed with tears, and surrounded with a lead- 
coloured circle. 

Baylis remarked the same, among the signs of 
poisoning by arsenic, that the sight was lost, to 
which supervened vertigo and syncope. 

J. Schneider makes mention of a case of poisoning 
by arsenic in a man thirty-six years of age. His 
aspect was ferocious, his eyes started from their 
orbits, and appeared bathed in tears, and the tears 
were so acrid as to corrode the cheeks. After 
death itself the effects of this horrible poison are 
manifested in the organ ofl^the sight ; and we 
must not neglect to take these effects into conside- 
ration with the other symptoms of the organiza- 
tion. 



142 



SEMEIOLOGY OF THE EYE. 



We have also found that the albuginea and the 
cornea of persons who have died from poisoning 
by arsenic, were absolutely similar to parchment 
which had been boiled and entered very slowly into 
putrefaction. 

Other terrible effects and phenomena which arse- 
nic produces in the organization, are described in 
the writings of Tr, Hoffmann, Ackermann, Berends, 
Pyl, Bosc,Gmelin,Gruner, Hahnemann, Isenflamm, 
Navier, Odier, J. Franck, Poldamus, Richter, Brodi. 
Orfila, &c. 

The acetate of lead (le plomb acidified) not only 
attacks the vegetative and irritable sphere of the 
organization, but affects, at the same time, the re- 
actions of the nervous activity ; it therefore pro- 
duces sadness, mental depression, vertigo, and an 
extraordinary despondency. 

We have also found, says Professor Loebel, in 
the different labourers employed at a manufactory 
of white lead at Naumburg, (to which he was at- 
tached as physician,) the eyes disturbed and 
dull, the sight gradually weakened, the pupil irre- 
gularly dilated, gutta serena forming, and the pa- 
tients terminating their miserable existence by 
attacks of apoplexy. 

To these symptoms are often united trembling 
of the limbs, and violent pains and convulsions. — 
(See Sprengel, Burdach, and Grossi.) 

Digitalis {digitalis purpurea,} taken in mode- 
rate doses, occasions a feeling of weight in the 
limbs, and a slight obscurity in the sight, with "an 



SEMEIOLOGY OF THE EYET. 143 

almost insensible dilatation of the pupil, a disa- 
greeable sensation in the stomach, vertigo, trem- 
bling of the limbs, a diminution in the frequency 
of the pulse, and a pulsative pain in the fronts and 
bottom of the orbits. 

Too strong doses produce convulsions, haggard 
looks, and dilatation of the pupil. The iris be^ 
comes of a brown red, excessive cold sweats su- 
pervene, and finally apoplexy and death. 

In other respects, the accidents caused by digi- 
talis are of long duration, and often reappear 
after having disappeared for a considerable time. 

The effects of opium on the whole organization- 
and particularly on the functions of the eye, are 
different according to the quantity taken and the 
quality of the article, and the natural tempera- 
ment of the individuals, for it acts differently on 
irritable and torpid subjects; its action is also dif- 
ferent on persons of a sanguine and on those of 
a phlegmatic temperament. 

According to our own observations, small doses 
of opium, such as an eighth or a quarter of a grain, 
taken every two hours, affect the sight agreeably. 
The eye becomes animated, the albuginea bright, 
and the look brilliant ; the iris a little retracted — 
in a word, the countenance resembles that of & 
person frantic with joy. 

On the contrary, when imprudent doses are ad- 
ministered, one grain for example, every two hours, 
it produces, it is true, momentary signs of gaiety, 
but ver}j soon after we see its sad effects not onlv 



144 SEMEIOLOGY OF THE EYE= 



displayed on the functions of the sensibility, but 
painted very visibly in the looks; the albuginea 
assumes a rose colour, and the eye and the coun- 
tenance become dull. 

After the administration of still larger doses, or 
a real poisoning by opium, the eye becomes fero- 
cious, the looks are wandering, and the iris is of 
a brown red colour. The pupil is never dilated 
to the extent observed from the effects of other 
narcotics, but resembles that of persons attacked 
with nervous apoplexy. 

On the contrary, the tinctura thebaica, or the 
liquid laudanum of Sydenham, has been for a con- 
siderable time, employed by us externally in dis- 
eases of the eyes and opacity of the cornea, con- 
nected with a slight inflammation in the albuginea 
and dilatation of the pupil, which had continued for 
a long time, without, however^ injuring the func- 
tions of the sight. 

Henbane {hyosciamus niger,) acts on the sensibi- 
lity of the organization, depressing and stupifying 
it, and from thence extending its action to the 
lymphatic sphere ; taken in large doses, it obscures 
vision. 

W. Wedel, describes its action on the organ of 
sight in the following words : " Ocularum et faciei 
" rubor, pruritus et gingivarum, quern solia pere- 
4i grina excitant;" and Avicennus says, in speaking 
of the hyosciamus : " Caligant oculi, spiritus diffi- 
" culter redditur, &c" 



SEMEIOLOGY OF THE EYE. 



145 



According to our own observations on the use 
of too large doses of the extract of hyosciamus 
niger, it produces yellowness of the visage, the eyes 
shine at first and then become dull, and the pupil 
considerably dilated. 

The celebrated Himly has seen paralysis of the 
iris follow the use of it. 

When the leaves of the fresh plant have 
been held over the eyes for some hours, the pupil 
becomes dilated, the iris immoveable, and the 
vision dull. — (See for the other effects of hyosci- 
amus, the Monography of Stoerck ; Libellus de hy- 
osciamo, Vienna?, 1765; and the writings of J. 
Franck and De Greding. 

Meadow anemone, (JJ anemone des pres, herba Pul- 
satillas nigrecantis ; anemone pi'atensis.^) The prin- 
ciple of the anemone is chiefly characterized 
by its specific action on the nerve of the eyes, 
which is manifested by a cutting or lancinating pain 
in the eyes, and is of great virtue in the gutta 
serena. 

Bergius relates an observation which was com- 
municated to him by Ch. Sauer, relative to a young 
boy, who from the vapours which arose during the 
inspissation of the juice of this plant, had his eye- 
lids red and lost his sight, but at the end of some 
days these symptoms disappeared. — (See Stoerck, 
Giese, and Murray.) 

Professor Loebel has seen, after the use of the 
powder of the anemone, prescribed in large doses 

by a quack to a journeyman, fifty years of age and 

I 19 

i 

I m 



140 SEMEIOLOGY OF THE EYE. 

very weak, horrible and lancinating headache fol- 
low, and especially pains in the eyes with obscure 
vision ; the pupil was only a little dilated, but the 
iris was somewhat tremulous; flushes of heat 
predominated over the chills, and this unfortunate 
man was tormented by inexpressible anxieties, dis- 
gust, vertigo, and cardialgia. 

These symptoms were accompanied with pains 
in the salivary glands, salivation, slimy and thin 
stools, and vomitings. The urine was bloody, with 
very strong pains in the bladder and urethra. 

The peculiar effect which this substance exerts 
over the sensibility and lymphatic system, and its 
individual action over the parts of the eye, has in- 
duced several physicians to make use of it in cer- 
tain species of amaurosis and cataract, and also 
in certain spots in the eyes. — But we will here 
end our reflections, it being our intention only to 
speak of the particular effects of this plant on the 
organ of sight. 

Deadly nightshade, (JWherbe et la racine de la bella- 
done, atropa belladonna.) This plant acts parti- 
cularly on the nervous parts of the eye, over the 
whole sensibility, and from thence its effects are 
extended over the lymphatic system of the organi- 
zation. 

Administered in small doses it produces spark- 
ling and flashes before the eyes, double vision, and 
fixed looks. 

It is seldom that we do not observe a sensation 
of dryness and tension in the oesophagus, vertigo. 



SEMEIOLOGY OF THE EYE. j[47 

drowsiness, anxiety, and, after a few hours, a free 
and copious sweat. 

In large doses it attacks violently the oscillation 
of the brain, which is disturbed in its reaction, 
from which result vertigo, temporary blindness, 
stupid insensibility, fury, spasms of the oesophagus 
and larynx, and convulsions. 

The eye has a ferocious look, the albuginea ap- 
pears a little dirty, the pupil considerably dilated ; 
the dilatation continues till death, which is almost 
always ushered in by paralysis. 

J. Franck relates the case of a boy three years 
of age, who had eaten freely of the berries of the 
belladonna, which he had mistaken for cherries. — 
His face, and the whole surface of his body be- 
came red ; the pupil considerably dilated and en- 
tirely immoveable. 

Daries cites a case in which the juice of berries 
of the belladonna injected in the eye, produced in 
a short time blindness, while the leaves simply ap- 
plied on the temples occasioned the dilatation of 
the pupil, and the immobility of the globe of the 
eye. 

The extract of belladonna in doses of a scruple, 
dissolved in half an ounce of aqua distillata, has 
produced momentarily the dilatation of the pupil 
and immobility of the iris. — (See Paget, Himly, 
and Franck.) 

Poison laurel, {Veau de laurier-cerise — aqua 
lauro cerasi.) This substance acts in a deleterious 
manner, particularly on the sensibility of the sys- 



|48 SEMEIOLOGY OF THE EYE. 

tern. In large doses it produces convulsions, teta- 
nus^ and violent and irregular spasms. In some 
cases it produces vertigo, paralysis, and apoplexy. 
In still larger doses it kills directly. 

This poison not only produces twitching pains 
in the brain and spinal marrow, but also in the 
eye. Under these circumstances we find this ori- 
gan extremely dull, aqueous, and moving very 
slowly. 

Compare with these remarks, the writings of 
Doell, Ittner, Emmert and Hufeland, who have ex- 
ceedingly well described the effects of the aqua 
lauro cerasi. 

Nux vomica, (La noix vomique,) administered in 
large doses, acts in a deleterious manner on the 
whole nervous system. It acts in such a manner 
as to occasion vertigo, headache, delirium, watcl> 
fulness, and great anxiety, without the patient en- 
tirely losing his consciousness. 

It attacks particularly every part of the eye. — > 
The eyes are painful, and appear to start from 
their orbits ; they are shining and sparkling, the 
albuginea is red and inflamed, the pupil extremely 
dilated, and we have frequently noticed a partial 
amaurosis to ensue. 

This substance administered in small doses, 
very soon excites convulsions, stupor, and death in 
animals born blind equally with others. 

Thorn-apple, (La pomme epineuse — datura stra- 
monium.) Not only the leaves, but also the fruit 
and the seeds of this plant produce deleterious 



SEMEIOLOGY OF THE EYE, 



149 



effects on the system ; it acts powerfully on the 
senses, and at the same time destroys sensibility in 
the vegetative organization. 

This plant, especially the seeds, produces drun- 
kenness, fury, enthusiasm, weakness in the organs 
of sense, and an insatiable desire of voluptuous- 
ness ; the eyes squint frightfully, the pupil is greatly 
enlarged, the countenance alternates with fixed 
and ferocious looks ; timidity and shame disap- 
pear, and a shameless feeling of lust torments 
those who have unfortunately used it to excess. — » 
See Sauvage, Haller, Boerhaave, Gmelin, Stoerck, 
Wadeberg, J. Franck, Paget, and Orfila. 

Gmelin, Abhandlung von den giftigen gewaech- 
sen. Ulm, 1775. 

Emmert, Diss, in med. prses. Kielmayer, de ve- 
nenatis audi Barussici in animalia effectibus. Tu- 
bingse, 1803. 

Docez, versuch ueber einige Pflanzengifte. 

Emmert, in der medizinisch- — chirurgischen zei- 
tung, No. 61, vom. 2. August, 1813. S. 162— -169. 

Hufeland, Beobachtung der schnellentoedtlichen 
wirkung der Blausaeure, in Journal der pracktis- 
chen. Heilkunde. Jan. 1813. S. 85. 

Orfila, Traite des poisons tires des regnes mine- 
ral, vegetal, et animal ; ou Toxicologic generale.&c, 
Paris, chez Brochard, 1814. 



150 



SEMEIOLOGY OP THE EYE. 



Description of the eyes, before, during, and after 
critical periods. 

Critical periods present to us three stages, which 
are manifested according to the degree of the 
disease, and the coincident influences, and these 
stages are not only indicated in the symptoms of 
the different organs, but the eyes especially pre- 
sent each of their different aspects ; they indi- 
cate the epochs of the disease, and especially the 
critical moments. 

It is necessary also to observe attentively the 
pulse, and other symptoms, with the view of re- 
gulating by these the precepts of therapeutics and 
dietetics. 

In like manner, when before the developement 
of the crisis, in the forming state of disease, there 
exists in the organization a sort of chaos, an 
irregular monomachy ; the same condition is de- 
picted in the eye. During this time the eye is 
restless, and the patient casts ferocious looks 
around him. 

At the moment of exacerbation the eye is red, 
inflamed, and shining, and a little before the crisis 
the ungovernable play of the countenance is carried 
to the highest pitch. We may there distinctly 
remark the contest of life with death. During the 
developement of the crisis, this wild play of the 
countenance ceases little by little, at least if life 
does not cease during the crisis. In this last case 



SEMEIOLOGY OP THE EYE. 



151 



the eye becomes unexpectedly calm and dull, the 
looks are fixed, and the iris, as it were, insensible. 
In the contrary case, it is very sensible to the light, 
which it dreads and avoids. 

Boerhaave has described, in a masterly manner, 
this period of the crisis in the following words : 

" Primaria ilia symptomata critica, et signa sunt 
44 haec, quae crisin evacuantem prsecedunt ; post 
" coctionem, tempore critico, subito, sine nova 
64 manifesta morbi causa, oriens stupor, somnolen- 
44 tia, sopor, vigiliae, delirium, anxietas, dyspnoea. 
44 nox molesta, rigor, dolor, rubor, titillatio, punc- 
44 tura, gravitas, densitas in parte, tenebrse, splen- 
44 dor, lux, lacrimal spontanea? in oculis, nausea, 
44 aestus, sitis, retractio hypochondriorum, tremula 
44 agitatio labii inferioris." 

When the developement of the crisis takes 
place in a happy and salutary manner, the har- 
mony of the functions of the organization is 
quickly re-established, life regains its powers, and 
we remark the return of calmness and mildness 
in the eyes ; the looks are agreeable — they have 
lost that wild and uncertain look that they had 
before. 

We cannot better compare this change than 
to the sky which becomes suddenly clear and 
bright, after having been covered with dark clouds 
and storms; the ferocious winds are calmed to 
rest, and the sun smiling anew in the azure vault, 
restores peace, repose, and fertility to all nature. 



152 SEMEIOLOGY OF THE EYE. 

After this critical revolution of the organization^ 
convalescence follows, and to this succeeds a per- 
fect cure, provided the developement of the crisis 
has been perfect and free from disturbance ; but 
should the crisis be interrupted, death frequently 
ensues. 

We here finish our remarks on the semeiology 
of the eye, and we repeat, with the divine Lucre- 
tius : 

f£ Multa tegit sacro involucra natura ; neque nullis 
" Fas est scire quidem mortalibus omnia, multa 
u Admirare modo, nec non venerare, neque ilia 
" Inquires quae sunt arcanis proxima ; namque, 
" In maribus quae sunt, haec nos vix scire putandum. 
" Est procul a nobis adeo prsesentia veri." 



IMPORTANT MATERIALS FOR THE SEMEIOLOGY 
OF THE EYE. 

De oculorum affectibus* 

Oculorum nitor, eorumque alba ex nigris et livi- 
dis nitentia, salutare. Ergo si pura brevi reddun- 
tur, ea puritas citam crisin ostendit ; sin autem 
serius, tardiorem. 



* Hippocrat. Coac. Lib. II. Ed. Paris, 1811. 



SEMEIOLOGY OF THE EYE. 153 



Oculorum caligatio, albumve rubens, aut livens, 
aut venis obsitum nigris, indecorum. 

Sed prava quoque sunt haec: lumen refugere, 
aut illacrymari, aut distorqueri, et alterutrum al- 
tero minorem fieri. Pravum est etiam, oculorum 
aciem crebro hue illuc volvere ; aut eamdem lemis 
tenuique pellicula obstrui, album increscere, nigrum 
diminui, aut nigrum etiam sub palpebra superior e 
occultari. 

Quin etiam prava sunt haec : oculi concavi et 
foras multum exerti ; turn sic perstricta oculorum 
acies ut potis non sit arnplificari pupillam. Prae- 
terea extimarum palpebrarum curvatura, oculorum 
concretio, aut ipsos continenter nictare, colorem 
mutare, nec posse palpebras dormiendo com- 
mitti, pestiferum. Mala est etiam oculorum per- 
versio. 

Oculorum rubra suffusio, febris experti, diutur- 
nam ventris affiictionem denuntiat. 

Quae circum oculos assurgunt pustuloe, dum 
refectioni opera datur, alvum prorupturam osten- 
dunt. 

Si ad perversionem oculorum laborioso febrici- 
tanti rigor accesserit, perniciysum. Turn comatosi 
in his gravissimum habent malum. Lippienti viro, 
superveniente febre, lippitudinis exsolutio : sin mi- 
nus, ccecitatis aut mortis, aut utriusque periculum 
est. 

Quae lippitudinem anteivit cephalalgia, aut inse- 
cuta firmiter, fixa haeret ; periculum co3citatis ad- 
fert. 

20 



154 SEMEIOLOGY OP THE EYE. 



Quae lippienti sponte diarrhoea cietur, saiubns, 
Oculorum hebetudo, concretio et caligatio, denun- 
tiat grave malum. 

Obscuratio oculorum cum exsolutione citam 
convulsionem ostendit. 

Oculorum caligo in morbis acutis, citaque hue 
illuc conversio, turbulentus etiam somnus vigili- 
aque ipsa, nonnunquam vero at sanguinis substilla 
e naribus, convulsionis praenuntia. Qui ad con- 
tactum minime sunt aestuosi, evadunt phreniticL 
magisque si sanguinem non profundant 

De observatione oculorum in acutis* 

Nunquam ab segro discedas in acutis et inflam- 
matoriis nisi oculos inspexeris. Quando illos a na- 
tural statu mutatos videbis, time semper, sicuti 
post opiatum in dysenteria, post chinae in magno 
primarum viarum apparatu. Constricto in his ca- 
sibus indebite humore noxio, praecipitat aeger, et 
praecipitii signa oculi a naturali statu mutati os- 
tendunt. 

Si oculi robusti non sint, mors imminet. Hippoc, 
2. Epid. sect. 6. 

Oculi audaces et fixi delirium minantur. 6. Ep, 
sect 1. 



* Georg. Baglivii Opera omnia medico-practica et anatomica;— ~ 
N Lib. I. p. 77. Norimb, 1751. 



SEMEIOLOGY OF THE EYE. 



155 



Si oculi lucem fugiant, aut involuntarie lacry- 
snentur, aut distorqueantur, aut prseternaturali co- 
lore mutentur: malum. Hippoc. 

Si, oculis clausis, alba eorum portio appareat, 
quod nori fiat ex alvi profluvio, aut delassatione : 
lethale. Hippoc. 

Ut valent oculi, sic et homo. Hippoc. 

Oculi, societas et vicinitatis jure, prae ceteris ce- 
rebri afflictionem denotant. Duretus. 

Oculorum rubor, in febre natus, diuturnam ven- 
tris molestiam denotat. Hippo. Coac. 40. 

Hallerius ait, oculorum ruborem esse signum 
corrupti pulmonis, aut viscerum — cerebri quoque 
et ventriculi inflammati ; fol. 1092 et 1096. 

Oculos caligare et obtenebrari, in pectoris acu- 
tis morbis, lethale, ut prae ceteris observavi in sene 
pulmoniaco apud S. Pantaleonem in montibus, in 
vico, qui ducit ad amphitheatrum Flavium, vulgo 
colosseum, et arcum triumphalem Constantini 
magni. 



The sight* 

The eye, that true interpreter of the thoughts, 
the passions, the temperament, and the intellectual 



* Chr. Gottfr. Gruner's Physiologische und Pathologische Zeich- 
enlehre zumgebrauch akademischer Varlesungen, und als Reperto- 
rium fur Praktiker. Jena, 1301. 



156 SEMEIOLOGY OF THE EYE. 

faculties, conducts the observer at the same time 
to a knowledge of the actual state of the mind 
and the body. 

The intimate connexion of the eye with the 
brain, the abdomen, the breast, and the other 
parts of the body, gives us the key to all that passes 
internally. 

The natural vivacity of the eye, if it exists in 
severe diseases, is almost always a good sign ; but 
if it is joined to bad symptoms, at the end of acute 
fevers, it becomes a suspicious sign. The healthy 
colour of the eye announces in persons in good 
health, the integrity of the functions and a perfect, 
state of health ; in sick persons, danger. 

The preservation of the sight, or its alteration, 
either in general, or in one or the other part of the 
eye, furnish us with a great number of different 
symptoms, more or less certain. 

Aversion to light shows itself most ordinarily in 
inflammations of the eye, and indicates an exak 
tation of sensibility. 

When it is accompanied by weakness, it denotes 
severe nervous symptoms. 

When it exists with headache and ferocious looks, 
it announces an inflammation of the brain. In con- 
valescence, it is a sign of weakness. In hysteria, 
in the gout, and other nervous diseases, it is of no 
moment. 

The scintillation (marmarygse) takes place in 
all diseases where the retina experiences an irrita- 
tion, either local or sympathetic. 



SEMEIOLOGY OF THE EYE. 157 

This symptom in persons in good health, and 
plethora following a congestion of blood, and in 
fevers, is without danger ; but in affections of the 
head, it is a sign of inflammation in the brain. It 
is necessary to take this into consideration after 
weakness and evacuations, but it is of little conse- 
quence n spasmodic diseases. 

It is the same in weakness (amblyopia,) and in 
obscurity of vision, (hebetudo visus, caligatio.) — 
These symptoms occur in weak persons and 
among gluttons and dyspeptics ; in plethora, a con- 
gestion of blood in old persons, and those ac- 
customed to vertigo or apoplexy ; in hypochon- 
driasis and hysteria, in nervous irritation, spasms, 
flatuosities and constipation ; in epileptics, an ap- 
proaching and severe accession; in an injury of 
the head, danger; in sedentary diseases, a ner- 
vous affection and augmentation of the weakness ; 
in acute fevers, with tension of the abdomen, 
bleeding from the nose with restlessness, trembling 
of the lips and vomitings ; in the moribund, pro-* 
gressive feebleness and death. 

Therefore, if the vision of the patient is ob- 
scured by the appearance of darkness before his 
eyes, it is in acute fevers a sign of the dangerous 
prostration of the powers of the system, and this 
symptom, when fever does not prevail, is the ordi- 
nary precursor of gutta serena. The constrast 
between the looks and the features of the patient, 
for example — a most placid calmness with signs of 



158 



SEMEIOLOGY OP THE EYE. 



internal suffering — is suspicious, and is often pro- 
duced by obstruction. 

If the patient sees objects inverted, it is a symp- 
tom which announces, in violent fevers, great irri- 
tation of the optic nerves ; after incomplete eva- 
cuations it indicates danger, and towards the 
termination of disease when united with prostra- 
tion of strength, approaching death. 

If the patient is under the impression that he 
sees a shining brightness, and if his looks are 
stern and wild, we may anticipate an alienation of 
mind ; if it is a sparkling light, with a false red- 
ness of the face, and paleness of the mouth, with 
a bilious constitution, with a mist before the eyes, 
spasms and weakness. 

The view of indeterminate and fantastic objects, 
such as insects, almost always supposes in persons 
in good health, a local defect in the organs of 
sight, weakness, and gutta serena; in hypochon- 
driacs and hysterical persons, an approaching 
paroxysm. In fevers, it is a sign of congestion and 
weakness. A brightness similar to that of fire, 
with or without redness, announces sanguineous 
congestion, and in acute fevers, delirium, bleeds 
ing at the nose, or some other hemorrhage. 

The view of double objects indicates, in intem- 
perate persons, congestion, a pressure of the organ 
of sight, and an imminent apoplexy ; in fevers, an 
idiopathic or symptomatic irritation and violent 
spasms : accompanied with prostration of the sys- 



SEMEIOLOGY OF THE EYE. 



159 



tern, it announces approaching death ; and, when 
it appears without any other disease, a local defect 
of the eye : at least, the symptom is insignificant 
in hysterical and hypochondriacal patients. 

Prominent eyes, with redness, leads us to presume 
an excessive congestion of blood, and makes us 
dread an appoplectic attack, or in cynancheal af- 
fections an approaching suffocation. 

Prominent eyes, fixed, very moveable, or winking, 
denote in acute fevers a local or remote irritation, 
spasms, congestion of the head, an increase of heat 
and delirium towards night ; in fine, imminent dan- 
ger and death. 

Haggard eyes, with the superior eyelid over- 
hanging the inferior, and an uneasy aspect, lead us 
to presume, in bilious and malignant fevers, that 
there is an accumulation of fecal matters in the 
prima? viae. 

Haggard and immoveable eyes denote mania, 
tetanus, convulsions : dull, heavy eyes, feebleness, 
and in fevers, danger and diminution of the vital 
powers ; in females, hysterical weakness. Looks 
turned towards the ground, announce in children 
hydrocephalus internus. 

The eyes deep buried or hollow, are, in persons 
in good health, a sign of a melancholy temperament, 
of distress and exhaustion ; among the voluptuous, 
of an excess in the pleasures of love ; among 
others, we must presume weakening evacuations : 
in diseases, the violence of the disease ; in conva- 



150 SEMEIOLOGY OP THE EYE. 

lescence, the continuation of the weakness and the 
slow progress of the re-establishment. 

Concentrated looks designate, in spasmodic dis- 
eases, a local irritation or a spasm of the muscles 
of the eye ; in consumption, an augmentation of 
the disease. 

The eye, drawn or contracted, announces 
spasms, or an excess of the pain of the convul- 
sions. 

The eye preternaturally enlarged, with redness* 
indicates an exterior violence or a congestion of 
blood ; the eyes becoming diminished or lessened, 
denotes spasm or atrophy from a pressure of the 
nerves or a derangement of the brain. 

The eyes glassy, in putrid fevers, announce 
danger : the eyes painful, without inflammation in 
fever, indicate irritation and danger. 

Half closed eyes during sleep, indicate, in chil- 
dren, symptomatic irritation from accumulated 
faeces, acidity, flatulency, and worms; in hysteria, 
spasms without danger ; in severe diseases, an aug- 
mentation of weakness and death. 

The eyes firmly closed, in acute fevers, announce 
spasm with dangerous symptoms, diminution of the 
powers of the system, lethargy, and approaching 
death. 

The eyes closed and winking, accompanied be- 
sides with favourable symptoms : a bleeding of the 
nose is critical. 

The watery and glassy eye is peculiar to the 



SEMEIQLOGY OF THE EYE. 



161 



measles. All the symptoms of which we have 
spoken, are sometimes united in a severe and 
dangerous disease, and then indicate an entire 
cessation of the vital powers, and approaching 
death. 

Strabismus, in insane persons, leads us to sus- 
pect an approaching attack ; among females, nym- 
phomania. A sudden strabismus of one eye. 
announces, in young infants, violent nervous symp- 
toms, and fatal apoplexy. Strabismus and mobi- 
lity of the eyes, hydrocephalus internus. 

The change of colour furnishes also signs more 
or less certain. 

A lead colour round the eyes, denotes in general 
weakness, cacochymy and cachexia, or obstruc- 
tions in the bowels ; in hysteria, spasms ; those 
who yield themselves up to the habit of the detes- 
table vice of onanism; libertines, debauchees, 
those subject to frequent pollutions or the go- 
norrhoea ; in chronic diarrhoea, enfeebling the sys- 
tem ; among females, the effect of the superabun- 
dance of the menstrual discharge, excess of vene- 
real pleasures or pregnancy; in the plethoric, a 
hemorrhage : in the cachectic, a fluor albus. 

The bluish tint in fevers, announces the progress 
of debility, and a fatal termination ; the pale tint, 
feebleness; the whitish tint, cacochymy; the 
natural colour of the sclerotica in severe diseases, 
the preservation of the powers of the system. 

If during sleep we see only the white of the 

21 



1^2 SEMEIOLOGY OF THE EYE. 

eye, we have reason to presume the increase of 
weakness and danger, especially in epilepsy in 
infants. 

The redness of the eye denotes sanguineous con^ 
gestion or stagnation, inflammation, metastasis of 
a morbific matter. 

The redness of the conjunctiva in typhus, de- 
notes a high degree of weakness ; in bilious dis- 
eases an irritation caused by the bile, but without 
danger. 

The yellow colour of the conjunctiva and albu- 
ginea is a symptom of jaundice. 

If a sick person is attacked by a pain in the 
side, and the albuginea is of a dirty colour, it is 
dangerous. A black and brilliant cornea, accom- 
panied with insensibility, indicates gutta serena ; 
a permanent brightness of the cornea inspires 
hope in diseases, and the restoration of the powers 
of the system in convalescence; a cornea too 
brilliant, with ferocious looks, announces in fevers, 
violent delirium and fatal convulsions : in spasms, 
congestion, and the loss of recollection. The di- 
minution of the brightness of the cornea is always 
a symptom of the diminution of the powers of 
the system, and indicates danger : the disturbed 
state and lessening of the eyes, with the silvery 
colour of the cornea, are ordinarily the precursors 
of death. 

The eyelids also furnish different relative signs. 
The tumefaction of the eyelids indicates relaxa- 
tion, cacochymy and cachexy ; after evacuations. 



8EMEI0L0GY OF THE EYE. 



163 



>,veakness ; in acute and malignant fevers, somno- 
lency; in lethargy, approaching death; in the 
scarlatina, anasarca. 

The lead colour of the eyelids, which supervenes 
suddenly, is a symptom of approaching weakness 
and danger, from the occurrence of internal gan- 
grene. 

The paleness and coldness of the eyelids in 
severe diseases, denote exhaustion; in hysteria, 
spasm ; in cachectics, a superabundance of mucus. 

The redness of the eyelids proves either a con- 
gestion or a stagnation of blood — a local or symp- 
tomatic irritation or inflammation. The eyelids 
half open; irritation and spasm of the elevator 
muscles of the eyelid ; after large evacuations and 
in fevers, a feebleness and fretful delirium; to- 
wards the close of disease, convulsions and death. 

The eyelids strongly closed and glued, denote 
much heat, delirium, weakness, and death. The 
eyelids shortened and reversed, accompanied or not, 
with the preceding symptoms, announce in severe 
diseases danger, and towards the close, prostra- 
tion of the vital forces and approaching death. 

In persons in good health tears are ordinarily 
the expression of pain or sorrow. In choleric 
persons and spoiled children, a sign of impatience ; 
in the melancholy, of trouble and chagrin ; in sick 
persons, of irritation and sentiment ; among per- 
sons of an irritable character and extreme sensibility, 
of the violence of the disease and imminence of 
danger, at least when a salutary bleeding from the 



164 SEMEIOLOGY OF THE EYE. 



nose does not take place ; in apoplectics they an- 
nounce anew fit ; towards the close of acute fevers, 
and when they flow involuntarily, approaching 
death. The diminution of tears in fevers, is the 
announcement of great heat, delirium, and phrenzy. 

A purulent matter in the angle of the eye, de- 
notes in infants a venereal affection ; among adults, 
a suppressed gonorrhoea ; among aged and caco- 
chymous women, the suppression of the menses. 

Adhesive humours in the eye, announce feeble- 
ness and irritation ; an acrid matter deposited on 
the glands, or an augmented or viscous secretion 
of the mucus of the eye, at the close of acute 
fevers, announce the progress of weakness, the 
prostration of the vital forces, and approaching 
death. 

Finally, we come to the symptoms drawn from 
the pupil, with, or without those which we have 
detailed. 

A cloudy spot behind the pupil indicates the 
white cataract. A dilated pupil, in severe dis- 
eases, indicates weakness, danger, and death ; in 
putrid fevers, a metastasis on the brain ; among 
infants, glassy stools, worms, and scrofula. The 
contraction of the pupil at the approach of light, 
announces a hydrocephalus internus; a pupil di- 
lated and paralysed, the gutta serena ; a pupil 
small and of a clear black, the sight good ; a re- 
tracted pupil, worms or spasms ; a pupil paralysed 
towards the close of severe diseases, announces 
approaching death. 



SEMEIOLOGY OP THE EYE. \(y( } 

We can consequently establish the following 
axioms : In proportion to the alarming symptoms 
which the eyes offer, accompanied by other symp- 
toms equally unfavourable, the greater is the dan- 
ger and the certainty of death ; and vice versa. 

Of the eyes and sight. 

The alterations of the sight and of the eyes, and 
their deviations from the natural state, present 
very frequently to the physician, materials from 
which he may deduce all-important observations. 
The natural sight, in a state of health, is subject 
to various morbific changes ; such as, for example, 
the double and multiplied sight, the fixed sight, 
the reverse sight, the obscure sight, the painful 
sight, the foresight, squinting, the appearance of 
fire, the sparkling sight, the appearance of various 
colours, of strange objects, of mist, of cloud, of 
imaginary and fantastic objects, aversion from or 
ardent desire for light. A considerable number 
of the morbific states of the body exert an influ- 
ence over the sight. It is not only in the diseases 
of the eyes themselves and the brain, but also in 
those of the breast and abdominal viscera, that 
the alterations which occur in the organ of sight, 
furnish us with very important data in the diagno- 
sis and prognosis of disease. 

In examining the eyes, we notice its brightness, 
vivacity, gaiety — its movements, direction, and 



166 



SEMEIOLOGY OF THE EYE. 



position — its prominence or embedded state, its 
changes of colour, its mobility, the dimensions 
and size of the pupil, its dryness and heat, the 
different kind of humidity and impurities with 
which it is embued, its ferocious aspect, its wink- 
ing, its spots, the state of the warts, tumours, ex- 
crescences, and a number of other accidents, which 
alone or variously combined, characterise and 
make known to us, either under the relation of 
prognosis or diagnosis, a great number of the dis- 
eases of the eye, as well as many other affections 
of the body, both general and particular. We read 
in the eyes a thousand important things, which 
cannot be known by any other symptoms. We 
remark there, frequently much better than in any 
other manner, the effect of words, the effects re- 
sulting from the action of medicine, and other cir- 
cumstances operating on the patient. 

The eyes announce frequently the movements of 
the soul, either past or present, such as chagrin, 
disgust, love, secret vices ; the desires, fear, hope, 
watchfulness and its causes, are almost always 
easily to be distinguished there, which conducts 
the physician to the most important researches, 
and frequently enables him to distinguish that 
which is true from that which is false in the re- 
presentations which are made to him of the patient. 
We should carefully distinguish the effects of 
affections of the abdominal viscera, of the womb, 
or the head on the eyes, from those which are 
produced by the affections of the soul, and com- 



SEMEIOLOGY OF THE EYE. 16? 



pare, in fine, the harmony of the looks with the 
features of the face. 

The eyes of infants are a faithful mirror ; the 
soul does not as yet express there any thing to 
deceive. When every thing seems lost, hope and 
consolation may yet beam in the eyes. 

It is extremely rare for a sick person, under 
whatever unfavourable circumstances he may in 
other respects find himself, to be in danger of 
death, while his eyes preserve their serenity. Ne- 
vertheless, in the opposite case, this does not 
always necessarily occur, for we have frequently 
seen patients recover, in whose eyes fire and anima- 
tion seemed entirely extinct. 

When the eyelids are closed, we must not neg- 
gleet, especially in diseases of the eyes, to open 
them at each visit, with the view of discovering 
their state. We must, besides, in cases of neces- 
sity, avail ourselves of all auxiliary means to satisfy 
ourselves perfectly of their condition — for example, 
a good view of the different positions and direc- 
tions, of the different degrees of light, &c. 

We can ascertain the sensibility and contracti- 
bility of the pupils by suddenly opening the eyelids 
after having kept them closed sometime, or by pre- 
senting before the eye a lighted candle, and then 
changing it suddenly. 



168 



3EMEIOLOGY OF THE EYE. 



Of the eyelids. 

The eyelids also offer many things worthy of 
remark, as for example : change of colour, relax- 
ation, tumefaction, ulceration, unequal closing, 
paralysis, dryness, inversion, spasms, convulsions, 
turning in of the eyelashes, which is frequently the 
cause of obstinate ophthalmia, the loss of the eye- 
lashes, &c. We must also examine the interior 
part of the eyelashes. 

Of the parts in the vicinity of the eyes. 

These furnish us also with equally interesting 
observations according as they are more or less 
swelled, sunken, part blue, red, &c. 

The lachrymal glands. 

The quality, the colour, the tumefaction of these 
glands, the voluntary or involuntary secretion of 
the tears, their quantity and their quality, present 
to the observing physician different important cir- 
cumstances, which cannot but be highly valuable in 
establishing the general principles of diagnosis. 



SBMEIOLOGY OP THE EYE. 



169 



The sight. 

If, in acute fevers, the patient complains that 
he cannot see, it is a dangerous sign, and almost 
always mortal, when the other symptoms indicate 
a great prostration of strength. This symptom 
is not less unfavourable in apoplexy and epilepsy. 

Among pregnant women blindness which super- 
venes suddenly, does not disappear ordinarily until 
after delivery ; sometimes it also depends on the 
accumulation of faeces in the primae viae, and the 
presence of worms. The diminution and obscu- 
rity of sight, and a disturbed and imperfect vision 
in acute diseases, are alarming symptoms which 
indicate oppression or debility of the powers of 
the system, and if other symptoms present con- 
firm this condition; if this state of vision suc- 
ceeds to syncope or convulsions, apoplexia and 
death may be expected shortly to follow. 

If the patient should not find the chamber suffi- 
ciently warm, it is a mortal sign, which we have also 
sometimes observed in puerperal fevers. 

An obscure or dull sight, succeeding to wounds 
of the head, announces considerable action, or an 
extravasation in the brain, and consequently dan- 
ger. Frequently also an obscurity of sight pre- 
cedes a bleeding at the nose or a critical vomiting, 
and it proceeds frequently from accumulation in 
the primae viae, with fulness of the head. In hv- 

22 



170 SEMEIOLOGY OF THE EYE. 

pochondriacal and hysterical patients, this symp- 
tom indicates the approach of a new paroxysm 
more violent than the preceding. 

If the patients complain of spots appearing to 
float before their eyes, we should apprehend in 
acute diseases delirium, and in persons in other 
respects in health, the cataract or gutta serena. 

The appearance of sparks before the eyes pro- 
ceeds from a considerable congestion of blood to- 
wards the head, and leads us to apprehend lethargy, 
apoplexy, convulsions, frenzy, and at critical pe- 
riods, a bleeding from the nose ; sometimes this 
symptom arises from the pressure of faecal matters 
in the primae viae. If patients are under the delu- 
sion that they see objects which are not present, or 
objects which have no existence, it indicates clan- 
ger, especially when accompanied by other alarm- 
ing symptoms. 

Double vision, (diplopia,) with a great prostra- 
tion of strength in hectic and other fevers, or- 
dinarily precedes death. Too great sensibility of 
the eyes, to the extent that they cannot support the 
light, is an alarming symptom in acute fevers. 

In opthalmias, if the inflammation is not consi- 
derable externally, but the pain nevertheless very 
severe, and the eyes very sensible, it is a proof that 
the internal parts of the eye are affected, and that 
blindness is to be feared. A pain in the pupil? 
without inflammation, is a dangerous symptom in 
acute fevers. 



SEMEIOLOGY OF THE EYE. 



171 



Besides, it is also proper to remark, that at the 
approach of a crisis, as, for example, by pers- 
piration, vomiting, diarrhoea, bleeding at the nose, 
&c. the eyes experience frequent changes, without 
any danger to be apprehended from this cause ; on 
the contrary, it is frequently a sign of convales- 
cence. 

We must consequently in these cases have re- 
gard to the period of the disease, to preliminary 
symptoms, and other circumstances. When the 
pupil is largely dilated, without, however, the sight 
suffering from it, it indicates almost always a feeble 
constitution, and is also a sign of worms, and of 
faecal and other matters in the primae viae, but we 
should always, at the same time, have regard to 
other symptoms in the disease. 

In hydrocephalus internus, the pupil is ordina- 
rily very dilated; it contracts when the eye is 
exposed to a bright glare of light, but it finally 
regains its primary dimensions in the same degree 
of light. 

In acute diseases, a considerable dilatation of 
the pupil is a dangerous symptom, and indicates a 
torpor of the brain. We remark this symptom in 
syncope, in the use of immoderate quantities of 
opium, in lethargies, and in the placid delirium 
which accompanies malignant fevers. 

A dilated pupil which does not contract at the 
approach of light, must be ranked among the 
symptoms of gutta serena. 



tf2 SEMEIOLOGY OF THE EYE. 

A small pupil indicates a proper degree of irrita- 
bility, and a good sight. 

In consequence of the presence of ascarides in 
the rectum, the pupil is frequently very contracted, 
and it regains its ordinary dimensions when the 
worms have been removed. 



Authors referred to in the course of this work. 



Aphorismi Hippocratis, accurante Theodoro Jansonio ab 
Almeloveen, M. L. Amstelod. COIIOCLXXXV. 

Hippocratis Coacse praenotiones, praedicta et praeceptiones. 
Nova editio, e typis Feugeray. Parisiis MDCCCX. 

Prosper Alpinus, de praesagienda vita et morte aegrotantium ; 
lib. 7. Venet, MDCI. in 4to. 

Sim. Paul Hilscheri Pr. de oculis, sanitatis et morborum judi- 
cibus. Jen. 1745. 

Herm. Paul Juch, r. Schiitz, Diss, de oculis, ut signo. Er- 
ford. 1748. 

Andr. El. Biichner, r. Oswald, Diss, de oculo, ut signo. Hal. 
1752. 

Keiln, Interpres clinicus. Francof. et. Lips. 1771. in 8vo. 
Petzhold, de prognosi in febribus acutis. Lips. 1778. 
M. Stoll, Aphorismo decognoscend. et curand. febr. Vindob. 
1786. 

Christ. Wilh. Haertel, Diss, de oculo, ut signo. Goetting. 
1786. 

Joh. Christ. Traug. Schlegel, Thesaurus semiotices patholo* 
giae, Vol. I. Standab. 1787, Vol. II. 1792, in 8vo. 

C. G. Selle, Rudimenta pyrethologise methodicce, edit. 3. 
Berolin, 1789. 

Heinrich Nudow, iiber die zeicheudentung des menschlichen 
Auges in Krankheiten ; aus dem Latein. Uebersezt ; nebst- 
reiner Vorerinnerung und einigen zussatzen. Nurnberg, 1791 . 
ia 8vo. 



174 



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Phil. Theod. Meckel, r. Fabricio, Diss, de signis morborum. 
quae ex oculorum habitu petuntur. Hal. 1793, in 8vo. 

Ferd. G. Danz, Semiotick, oder Handbuch der Allgemeinen 
Zeichenlehre, zum gebrauche fiir angehende Wundarzte. 
Leipzig, 1793. in 8vo. 

G. Prud. Boehmer, r. Herrich, Diss, de ophthalmoscopia. 
pathologica. Ditcberg. 1794. 

Samuel Gottlieb Vogel, das kranken examen. Stendal. 1796. 

Joh. Christ. Reil, iiber die Erkenntniss und Curder Fieber. 
Halle, 1799. Bd. 1. 

W. Cullen, Anfangs griinde der praktischen arzneykunst. 
Dritte ausgabe. Leipzig, 1800. Bd. 1. 

Kurt Sprengel, Handbuch der Semiotick. Halle, 1801. 

Christ. Gottfr. Gruner, physiologische und pathologische 
zeichenlehre, zum gebrauch academischer Vorlesungen. Dritte 
vermehrte ausgabe. Jena 1801. 

J. B. de Quarin, animadvers. pract. in divers, morb. Edit, 
aucta. Vienna?, 1814. 

Imman-Meyer, iiber die natur der entziindungen. Berlin, 
18 :0, in 8vo. 

W. G. Conradis, grundriss der Pathologie und Therapie. 
Theil. II. Bd. 1. S. 112—165. 1811. 

Wolfarth, iiber die Bedentung der zeichenlehre inder Heil- 
kund, 1811. 

Alexander Haindorf, versucheiner Pathologie und Therapie 
des geistes und gemiiths-krankheiten. Heidelberg, 1811. 

Karl Schottin, gedichte, nebsteinem anhange iiber das auge 
in asthetischer Hinsicht ; zum besten nothleidender armuth 
herausgegeben miteinem Kupfer. 1717. Koestriz. in 8vo. 

C. W. Hufeland, Erlaiiterungen seiner zusatze zu Stieglitz 
Schrift iiber den animalischen magnetismus. Berlin, 1817, in 
8vo. 

Allgemeine medizinische zeichen Lehre von. Doct F. G. 
Danz, fiir angehende aertze ; neu bearbeitet von Dr. J. Ch. 
Aug. Heinroth, Leipzig, 1812. 

A. G. Richter's specielle Therapie. Berlin, 1813. 



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175 



Carol. H. D'Zondii, de infiammatione aphorismarum liber 
primus. Hal. 1814. in 8vo. 

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K. G. Schmalz, Versuch einer medicinisch-chirurgischen 
Diagnostick in Tabellen. Dresden, 1816. 

Wilh. Andr. Hoase, liber die Erkentniss, und curder krank^ 
heiten des menschlichen organismus, 2 Bde. 1817. 



Titles of different works 'published by the Author, 

Lecons du Cit. Alphonse Le Roy, sur les pertes de sang. Paris. 
1 800. Translated into German by Dr. Zadig, of Breslau. 

Recherches et Observationes sur le Phosphore. Strasburg, 1815. 
A Review of this work, very flattering to the Author, is inserted in 
the Medical Repository, Vol. III. p. 205, New- York, 1815; and in 
the Eclectic Repository and Analytical Review, Vol. III. p. 125. 
Philadelphia. 

Traite sur les Vins dans les maladies dangereuses et mortelles, et 
sur la falsification de cette boisson, por le Professor Loebel, translated 
from the German into French, by the Author. Strasbourg, 1808. 

0 A General Guide for Practising Physicians in the examination of 
the Sick ; with an Appendix of medical formulae. Philadelphia, 1823, 

Researches and Observations on the use of Phosphorus, in the 
treatment of various diseases. Philadelphia, 1825. 



Works intended to be published by the Author when his occupations 
will permit. 

On the Nature and Cure of Epilepsy, with medical formulae, 8vo. 
300 pages. A work entirely new, and important to every member of 
the profession. 

Treatise on Hemorrhages during pregnancy and the period of 
labours ; abortions and of all kinds of hemorrhage, and of the bene- 
ficial effects of the acetate of ammonia, administered by the author 
in different cases of difficult menstruation. 

The present State of Medicine in North America; the diseases 
incident to the climate, and the cause of the frequent occurrence of 
gravel, with some account of the success of the author in relieving 
this disorder. 

Topography of the city of Philadelphia ; with observations on the 
civil, commercial, and literary character of the United States. 

The author also intends, if his occupations permit, to publish r 
Topography of the city of New-York. 



SUBSCRIBERS' NAMES, 



CITY OF NEW-YORK. 



Professors of Rutgers College. 
David Hosack, M, D. 
.John W. Francis, M. D. 
Valentine Mott, M. D. 
Wm. James Maeneven, M.D. 
G. McCartney Bush, M.D. 
Professors of the College of Physicit 

and Surgeons. 
A. H. Stevens, M.D. 
Joseph M. Smith, M.D. 
John Torrey, M. D. 
John B. Beck, M. D. 
Edward Delafield, M. D, 



Dr. Samuel L. Mitchill 
Felix Pascalis 
Samuel W. Moore 
Daniel L. M. Peixotto . 
Benj. B. Coit 
John Watts 
Wm. Hamersley 
Samuel Akerly 
Ph. Albuzzi 
Wm. Anderson 
Wm. Barker 
Jas. Bayley 
Hervey Baylies 
B. Belden 
Francis E. Berger 
John M. Bernhisel 
F. A. Bliss 
Samuel Blois 
R. M. Bolles 
Thomas Boyd 
Samuel Boyd 
John G. Cheesman 
Thomas Cock 
James Cockcroft 
E. Conway 
A. McCurdy 
Daniel Dayton 
A. H. Dei-ins- 



Dr. Patrick Dickie 
John Dodd 
G. Van Doren 

C. Drake 
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J. W. Duvall 
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15 Ph. J. Ferguson 
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Israel Green 
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Richard R. Hoffman 

A. J. Hunter 
W. M. Ireland 
Hudson Kinsley 
David Kissam 

J. M. Scott McKnigh^ 

P. H. Lalouette 

John Lauth 

N. McLean 

E. Mead 

Samuel Osborn 
j J. M. Pendleton 
I Wm. Piatt 
j Wm. Power 

Peter Pratt 

J. Randolph 

D. M. Reese 

B. R. Robson 
Wm. L. Rushton 
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James Stewart 

E. Storer 
John G. Vought 
Henry Van Housenber^ 
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M. Willett 
j Fr. Winthrop Walsh 
I A. Wright 



subscribers' names. 



Students of Rutgers College. 
Mr. Thomas Ackerman 
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W. H. Ellet 
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John H. Griscom 
Amos G. Hull 
Rob. S. Marshall 
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W ? Walters 



Gentlemen who are friends of Science 
and Literature. 

Chevelier Durand St. Andre, Fr. 
Consul 

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Editor of the Le Courier des Etats 

Unis. 
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PHILADELPHIA. 



The Count of Survilliers, Joseph 
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His Excellency— Niederstitter, 
Prussian Minister 

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ish Consul 

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Thoet, Sardinian Consul 

The hon. J. Andr. Shultze 

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Professors of the Medical Faculty of 
Pennsylvania. 

J. Redman Coxe, M. D. 

Th. C. James, M. D. 

N. Chapman, M. D. 

Wm. Gibson, M. D. 

Robt. Hare, M. D. 

Wm. P. Dewees, M. D. 

Wm. E. Horner, M. D. 

Th. T. Hewson, M. D. 

S. Jackson, M. D. 

G. B. Wood. M. D. 



Professors of the Jefferson Med, JBiti- 
John Eberle, M. D. 
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Physicians. 
Dr. G. F. Alberti 
M. Anderson 
Thomas Ash 

E. P. Atlee 
Franklin Bache 
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F. S. Beattie 

A. Bournonville 
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Robert Bridges 
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B. Burdon 
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SUBSCRIBERS 5 NAMES. 



Dr. J. B. Dick 
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